Patients Aren’t the Only Angry Ones by Pat Conrad MD


Over the past decade I’ve managed to get the occasional piece of hate mail for giving a public opinion on topics. Some of you won’t like this one, but rest assured, I mean every word. I enjoy Medical Economics magazine to whom I sent this letter. Just in case it doesn’t get published, I thought to share it with the home crowd. And yeah, I redacted the name and location on this randomly chosen photo so as not to give any undue publicity to an enemy.

To the Editor:

The cover article from your 4/25 issue, “Your Best Malpractice Defenses” was well-intended to help physicians minimize their liability potential, yet every recommendation is predicated on what the defendant is doing wrong. The entire approach still amounts to devoting more of an ever-dwindling day to negative purposes (It was particularly sad that the article needed to quote an attorney on the importance of reading body language for non-verbal cues).

The article noted that patients sue out of anger. While this is very true, other important contributors are greed, stupidity, and vengeance. The article quoted a past-president of the AAFP advising against viewing each patient as a potential lawsuit. Quoting an AAFP official says less about the actual malpractice environment than it does about the misguiding psyche of that organization.

The simple, unbalanced equation is that any patient, or vengeful surviving family member can take a shot at a physician at any time with no consequence, and often enough get a nice cash prize for a settlement. Every patient IS a potential lawsuit. Moonbeams pretending that the issue rests on good care and communication are both naive and irresponsible.

Later in the 4/25 issue there is an article on “The ethics of researching patients on the web.” The author – another attorney – notes that while it is widely accepted for a patient to Google a physician, the reverse is “more controversial.” That article worries that while legal, researching a patient might erode that patient’s trust in the physician, and concludes that such searches would be “inadvisable.” Again the doctor-patient relationship is presumed to be a one-way street, where only the patient has the presumption of good will.

Today the article would be more precisely titled “The Doctor is Always Wrong.” Doctors are targets, and should behave as such until they are able to retire.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  7 comments for “Patients Aren’t the Only Angry Ones by Pat Conrad MD

  1. Kurt
    May 20, 2015 at 3:05 pm


    “Read body language?” How the hell is anyone going to do that with their nose buried in
    a laptop? 🙂 🙂

  2. T Newberry
    May 20, 2015 at 2:49 pm

    Pat, I think your points are all good. But forget about anger, greed, stupidity and vengeance. The best predictor of a malpractice lawsuit is how much the patient and their family personally like or dislike the doctor. I didn’t read the article, but your best defense against lawsuits is a pleasant disposition.

    Perry, it sounds like you have been touched by malpractice. I’m sorry about that. But your claim that medical malpractice is a “tremendous waste” is overstated. If we eliminated all medical malpractice claims and the much more costly “defensive medicine” practiced to avoid claims it would reduce total healthcare spending by less than 3%. Medical malpractice claims are a huge pain in the ass to doctors, but they are a tiny drop in the bucket of total healthcare spending. I mean, if facts matter.

    $1,668,000,000,000 with malpractice.
    $1,613,000,000,000 without malpractice.

    • Pat
      May 20, 2015 at 3:12 pm

      T, the “disposition” predictor is the accepted wisdom but from experience, I don’t buy it. I think the best predictor is outcome first, and second, whether all the available imaging modalities were used, regardless of the clinical situation.

      Could you point me to your info re: defensive medicine? I’ve read various studies that put the defensive costs I’m the tens, to hundreds of billions, and while I’m not pushing any set number, I’ve got to think the cost higher than 3%.

      • T Newberry
        May 20, 2015 at 4:43 pm

        Pat, I will defer to your experience. I read an article a few years ago about the disposition predictor. I was struck by the story of a family that had a baby with some complications. They wanted to sue the anesthesiologist, but in their lawyer’s opinion the malpractice was committed by the obstetrician. The family refused to sue because they really liked the obstetrician but hated the anesthesiologist. Presumably they shopped for one of Perry’s sharks to do what they wanted.

        The specific study I looked at was done by the Harvard School of Public Health and published in US News & World Report in 2010. I am sure the numbers have changed somewhat, but they estimated the total cost of malpractice to be $55.6 billion, with the vast majority, $45.6 billion, coming from defensive medicine. This is in line with a figure I learned in a class on Coursera, so I assume it to be accurate-ish.That is a big number, but a small fraction of the $1.686 trillion U.S. healthcare industry.

        • Pat
          May 20, 2015 at 6:17 pm

          Thanks T, I’ll try to read and follow-up. It’s a crazy mess but like you, I want to try to be as factual as I can. Cheers.

  3. Perry
    May 15, 2015 at 11:33 am

    Lawyers have been compared to sharks, but I think that’s too complimentary. Sharks are animals and predators and that’s how they are supposed to be. Lawyers are human predators that prey on the sick, injured and grieving. Our so-called healthcare reform has failed in many ways, but specifically in not containing the tremendous waste of malpractice litigation.
    The legal profession has gone way beyond protecting the innocent, into becoming leeches on society, which will be the death of freedom in this country.

  4. Dr Bonz
    May 15, 2015 at 9:01 am

    “…Doctors are targets, and should behave as such until they are able to retire.”

    And even then, they STILL remain targets. Don’t forget why we have to buy “tail” coverage along with our malpractice insurance. Two year statute of limitations and 18-20 years if the patient is a child.

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