CYA Medicine

As a follow up to my last post, I think I need to explain to y'all what CYA medicine is. Have you heard of it? Do you know what it means? At its core, CYA medicine means 'Cover Your A$$.' Don't do anything that will get yourself sued. Document everything. Make the patient look like the Bad Guy. Don't neglect good care. Be conscientious. Practice good medicine. Don't get caught missing anything.

Often this is as simple as ordering extra tests. Extra blood work. Extra labs. Extra xrays. Anything to make the patient happy. A good Patient Satisfaction Score has nothing to do with the quality of care they received. It has everything to do with their perception. And most patients believe that more tests equals better care. But we know better. We are just covering our butts. We want you happy so you don't sue us. And there lies the baseline problem with America's medical problem. We spend too much money just to keep the lawyers away. Just because you have a snotty nose and a cough, you do not necessarily need a blood test, a flu test, and a chest xray. The End.

Anyhow, how does this relate to my previous post, and why I am I addressing this now? Because that is what the local neurologists did. They were practicing CYA medicine. By not letting me back into the hallowed sanctum of a clinic room to be seen, they were not liable. If they had let me into a room, and if they had laid eyes on me, even accidentally, they would be responsible for whatever happened to me next (according to our wonderful litigious society). By having a nurse serving as a go-between, they officially never saw my face and therefore, have nothing to fear from a lawsuit. Instead, by insisting that I leave after having a chart made, they can write 4 magic letters on my chart: LWBS (Left Without Being Seen). This means, in the eyes of the court, that I came to the clinic, had a chart made, and for whatever reason I DECIDED ON MY OWN to leave.

Note the difference in reality. The reality: I was told to leave, and the doctors refused to see me in their clinic. The chart reality (or the CYA reality): I 'Left Without Being Seen.' A very subtle difference, but one that puts the fault on me if I had emergently gone blind or herniated. I guarantee you that the truth of that encounter was not documented anywhere but here. 'If you didn't write it down, it didn't happen.' Those are the exact words we are taught in med school and residency. Document everything...but only if you want it to show up in court. If it's not documented, it didn't happen. Scary, huh?