Fear of Lawsuits Drives Doctors to Test and Test and Test

Why do doctors order so many tests? If the results of a new study are anything to go by, doctors are more afraid of being sued for malpractice than they are of suffering the wrath of patients and/or insurance companies over the costs of those tests.

A stunning 90 percent of doctors surveyed in a recent study (published in Archives of Internal Medicine) of more than 1,200 physicians across the U.S. reported that they erred on the side of more and more testing and treating in order to protect themselves from the dreaded malpractice lawsuit — which might come anyway. Buttressing many of the fears cited by the doctors involved in the study was data from malpractice lawyers suggesting that too little testing was an allegation of many a malpractice lawsuit. Yet how much is too little and how much is too much? These days, more and more doctors are not wanting to get anywhere near "too little," especially in the emergency room, where the sometimes life-or-death margin is razor-thin.

Testing to uncover reasons for symptoms or to head off diseases or debilitating conditions (read: defensive medicine) is good, standard medical practice and has been so for a great many years. But in the day of the all-too-easy lawsuit, many doctors are looking to protect their livelihood by possibly overestimating the need to look into the livelihood of their patients. "Better safe than sorry," but safety has degrees and thresholds, unlike the menace of a malpractice suit, which seemingly knows no bounds or minimums.

Medical malpractice insurance rates are through the roof and show no signs of coming down out of the sky. Doctors live in fear of misdiagnosing, mis-treating, and just plain missing things. Being human, doctors will make mistakes. (And it's all well and good to argue that doctors have people's lives in their hands, but the same could be said for bus drivers, airline pilots, construction workers, teachers, and other people to whom we hand over our safety for bits of time each and every day. We can certainly file a lawsuit against a bus driver who crashes the bus we're on or the construction worker who doesn't seal off the building site properly, resulting in an injury; but those people live in nowhere near the amount of fear or trepidation that doctors do.

A secondary result of all this expensive medical insurance is that rural areas are attracting fewer and fewer doctors because the physicians can't afford to make a living above and beyond the extraordinarily high costs of insurance, malpractice and otherwise.

If doctors are ordering too many tests because they're afraid of being sued, then we've got a runaway lawsuit culture. This has been the case for years in other areas, and the results of this latest study only better support that assertion.

The Kiss Worth a Thousand Words

Writers like me probably don't like to admit this, but the cliche really is true: A picture is worth a thousand words.

The most recent well-publicized example of that maxim was the re-publication of the famous V-J Day photo showing an American sailor kissing a nurse amid the celebrations that took place for weeks after the announcement that World War II had finally, exhaustively ended with the surrender of Japan. This photo summed up what many people were feeling during those heady times:

• relief: the men and women who survived the war would be coming soon. Indeed, this sailor was already home and showing how happy he was about it.
  
  
• sadness: on the part of the nurses like the woman in the photo, who had cared for so many sick, injured, and dying during the seemingly never-ending days and nights when the world was at war.
  
  
• exhilaration: at the idea that the "winning" side in the war was not the totalitarian regimes of the Axis powers but, rather, of the representative-government countries known as the Allies.
  
  
• happiness: more than anything else, the kiss is a symbol of joy, of shared attraction, of experience binding two people together, if only for a fleeting moment.

All of those words together do not equal the power of that one image, beautifully photographed.

The photo, published by Life magazine, made even more famous the name of Alfred Eisenstaedt, already a well-known photographer. It also created quite a mystery as the identify of the two people kissing.

Long after the initial publication, in 1980, when retrospectives had published the photo again and again, Eisenstaedt gave the name of the nurse: Edith Shain. Her name and her famous photo became headlines again this week, when she died at 91. In the 30 years since she was identified, she got the opportunity to lay wreaths at veterans cemeteries and otherwise remember those she cared for and those who didn't make it back.

She also got to meet the sailor again. Turns out he was Carl Muscarello, now a retired police detective. The two met again, knowingly this time, in 1995 and were friends until Shain died.

Their moment in time, frozen in the black-and-white image that symbolized all of those ideas, is part of our history, a part that resides in the head and the heart and the memory as an image that needs no words.

Patriotism: Much More Than Wearing a Gun on Your Head

What is it about guns that so fascinates or infuriates people, especially Americans? We have a 2nd Amendment that gets trotted out every so often defend or condemn a situation. We have a long history as a country of winning armed conflicts. Now, apparently, an 8-year-old boy can make a political statement by bringing toy guns to school — on his head.

Here's the story: The boy got all fired up about making something for a school project. The teachers said that all the projects should have a patriotic them. So the boy got some Army figures and glued them to a baseball cap. The cap was of a camouflage design, and the appearance of toy soldiers on top of a camouflage cap was surely patriotic, the boy must have thought. So he glued the soldiers on top of the hat and bill, put the hat on his head, and went to school.

Trouble was, the toy soldiers were holding guns. Now, I used to play with toy soldiers as much as the next little boy, and I can tell you that most of those soldiers were holding guns. These were soldiers who were or were going to be on the battlefield. Of course they would have guns! These little guys were maybe two inches tall, and it was always clear to me that not only were the soldiers not real but also the guns those soldiers were carrying were not real.

Such was the not the case with the superintendent of this boy's school.

Seems the boy got tossed out for bringing weapons to school, the weapons being the tiny guns held by the tiny soldiers atop the boy's school project.

The boy's situation became known to the head of the state National Guard, who went out of his way to present a special medal to the boy. What far? Why, for showing his patriotism, of course.

The story made the rounds of 24/7 media in which we now live, and the pressure must have really been put on the superintendent, for he recently announced that he would have a another at the school's weapons policy, to make sure that a similar occurrence wouldn't happen in the future.

It should also be mentioned that the school sponsors an Air Force Junior ROTC program and that the school district was very familiar with military matters.

All well and good, right? Not necessarily. There's still the matter of the "patriotism" displayed by the boy in the first place. One person's patriotism is a pro-gun policy; another person's patriotism doesn't involve guns at all. Surely the presence of a gun isn't required to display love for one's country? Soldiers who go to war to defend their country are definitely putting their lives on the line. Those who die have indeed given their "last full measure of devotion." But those are symbols of the belief in one's country and its preferred way of life, not the sole ends that justify the means. Let's take a step back here and think about what it means to be a patriot. Surely it's not so simple as carrying a gun.

Firing Squad, Tweets: Let It Go So the Victim's Families Can Have Closure

"I just gave the go ahead to Corrections Director to proceed with Gardner's execution."

Those were the words that came from Utah Attorney General Mark Shurtleff just before the execution of convicted killer Ronnie Lee Gardner. The how and the why of both the execution and the communication are ultimately more interesting.

First, there are the how and why of the execution. Gardner, who had been on death row for several years, had requested that he be killed by firing squad instead of by lethal injection, the state of Utah's official method of putting death row inmates to death since 2004. That law wasn't retroactive, however, and Gardner, already on death row when the law came in, had the option, so he took it. Such was his choice, every bit as viable as the choices that he made that led to the crimes for which he was convicted and put away. The debate over whether which form of state-endorsed execution is the more humane will no doubt continue, as will the debate over whether such execution is cruel and unusual. However, under the laws of the land of Utah, Gardner's method of execution was both permissible and possible. Why did he choose it? He has certainly garnered a lot of publicity in recent days, and he will be forever linked to Gary Mark Gilmore, whose final words are echoed in Nike's call to athletic arms. He was on record as saying he wanted a quick end. The firing squad certainly delivered on that count.

Juxtaposed against the debate over how Gardner was killed is the method of communication that the attorney general used to tell the world what has happening. Shurtleff used Twitter.

Certainly the lightning-quick communication method of the moment, Twitter is the choice of millions of people these days, who share the most mundane, intimate, and otherwise important details with anyone who wants to "follow" their 140-character-at-a-time bursts of words and deeds. So Shurtleff, in wanting to get the word out, typed some characters into his Twitter account and pressed Tweet.

Was he callous in doing so? Was he reveling in his role in what many people are calling a return to "old-time justice"? Probably not. He was just doing his job, albeit by choosing a 21st-century mode of communication. In olden times — meaning 10 years ago — he would have typed something up and sent it out to the media or sent a FAX or phoned it in. Now, in the heady light-speed days of email, Facebook, and Twitter, that's how people communicate.

So, the method of execution and the method of the communication announcing that execution can both be argued against and defended. Where does that leave us? In a quandary?

One thing we can probably all agree on is this: What has gotten lost in these twin debates is what happened to Gardner's victims and their families. The second part of Shurtleff's Tweet was this:

"May God grant him the mercy he denied his victims."

In all the hand-wringing over whether to put this man to death, people forget that he killed. He killed a man outside a bar in 1984; for that, he was on trial. Someone slipped him a gun before his pretrial hearing in 1985; during his attempted escape from the courthouse, he killed a lawyer in cold blood.

Those are facts. The anguish he caused his victims will never be extinguished and will, in fact, be made even more painful as long as the twin debates mentioned above continue.

Don't Mess with Mickey Mouse

Some cultural icons just don't stand up to ridicule — or being otherwise messed with. Such is the case with Walt Disney's most famous creation, Mickey Mouse.

Seems the famous mouse is the star of a Wii game on the horizon titled Epic Mickey. Apparently, you can help the Mouse decide whether to help creation characters out of jams or make tough decisions, all in the virtual world of Wii.

This being an electronic game, you can also convince your avatar to do things that are either naughty or nice. And it's that word naughty that comes in handy now because word leaked out, from a variety sources (namely the ones who had seen for themselves), that the game's image of Mickey Mouse would morph into an image evocative of what the game-player had just ordered the game character to do. Have Mickey steal money or other things, and the result is an evil-looking Mickey.

That was a bridge too far to nearly everyone who saw the images, play-tested the game, or otherwise heard about this plan to show Mickey Mouse in a not-so-positive light. Many people didn't even want to know how Mickey would look differently. The point was, they wanted Mickey to look like Mickey, the same as he always has. When you're a cultural icon of those gigantic proportions, you tend to be recognizable. And more often than that, the people who have seen the evil-looking Mouse in Epic Mickey found themselves thinking something along the lines of "That's just plain wrong."

Such has been the outcry that the makers of the game have retouched Mickey, to bring him more in line with the traditional image, with the exception that if you do order him to do something bad, his character will appear to have smudges around the edges, which most people probably won't even notice. That's a far cry from Mickey breaking out into a maniacal grin or some such negative portrayal of the one Disney icon who seems always to be happy.

That's the point, really. Mickey is always happy, even when he's not. Mickey Mouse is an image that is so frozen in people's minds that messing with that image is similar to trivializing a religious figure or offending the proponents of a religion.

The lesson here? Don't mess with the Mouse.

Kindness Saves Lives – Literally

Sometimes, a smile can change someone's life — or, in the case of Don Ritchie, actually save a life, many times over.
Ritchie lives in a house not far from The Gap, a stark cliff overlooking Sydney Harbour off which more people throw themselves than any other place in Australia. Local officials say that the average of people who commit suicide by jumping off The Gap is about one a week. If it weren't for Don Ritchie, that number would be a lot higher.

The fence would be a lot higher, too, if the local council's approval for funding gets approved. The fence keeping people away from the edge is currently only three feet high — more than low enough for someone determined to jump off the cliff to scramble over on their way to their death.

Ritchie is what many people call "an angel who walks among us." What he does, quite simply, is gently coax the suicidal back to the world of the living — with a kind word, the offer of a cup of tea, and (most of all) a smile.

It is that smile that has saved many people, not only at The Gap but also elsewhere in the world. An apocryphal story out of San Francisco tells of how a man who jumped off the Golden Gate Bridge (another prime destination for those wishing to end their lives by jumping from a height) left a note saying that if he saw one person smile at him, he wouldn't jump. Sadly, authorities found the note after the man had jumped.

A similar story comes from a man who jumped from the Golden Gate Bridge — and survived. He paced along a sidewalk on the bridge for nearly 40 minutes, agonizing over his state in life. He promised himself that if one person showed him an ounce of kindness, he wouldn't jump. Many people, oblivious to all but their own concerns, passed him by. A tourist did stop but only to ask the man to take her picture.

But back to Don Ritchie. He's 84 now (in 2010). He and his wife, Moya, have been married for 58 years. They have lived near The Gap for 50 years. The number of people that he has convinced not to jump is high, he insists, although he doesn't keep a running count. (The official count kept by the local council, however, stands at 16-0.)

He has lost a few, including a boy who listened calmly and carefully to Ritchie's side of the conversation before jumping anyway. (The wind blew the boy's hat into Ritchie's outstretched arms on that occasion.)

More often than not, though, the people come back from The Gap, after listening to and talking with Ritchie. Sometimes, they come back to his house for a cup of tea. Other times, they walk away and get on with their lives.

Some people never forget the kindness of Don Ritchie. One woman who turned from the edge thanks to Ritchie returned to his home awhile later with a bottle of champagne and continues to make a point of writing to him once a year, reminding him of his kindness toward her and updating her on her successes in the world of the living.

The Australian government has awarded Ritchie its highest honor, the Medal of the Order of Australia. He and Moya were named their local council's 2010 Citizens of the Year. Long retired (from a career in — seriously — life insurance), Ritchie now spends his time with his wife. Not as active as he used to be, he enjoys reading. (His current read is the Dalai Lama's The Art of Happiness. He is determined, though, to keep watch and keep on offering a smile, a kind word, and a cup of tea — as long as he is able.

This Wristband Can Save Your Life – and Your Workout

Now here's an innovation I can get behind: an ID bracelet that's also an e-wallet. It's perfect for my current favorite participation sport: running.

The bracelet that people with rare or otherwise notable medical conditions wear is familiar, as is the purpose: These people wear these bracelets so that communication can be done for them if they are incapacitated. In other words, if someone suffers bad reactions to a certain kind of drug, then medical professionals certainly shouldn't be administering that drug in response to the person's passing out cold on the floor.

So that's all well and good because it will keep someone alive in the event of their not being able to warn against certain treatments and such. A couple of entrepreneurs, though, have taken this step a bit further.

Their innovation (and sadly, no actual pictures are available so the generic one at right will have to do) is indeed a medical-profile wristband, onto which a number will be emblazoned. That number will be linked to a database that contains the medical profile that the wristband-wearer approves, alerting other people to such things as name, emergency contact's name and phone number, name of the person's doctor, and even the name of the person's insurance company. Fantastic! The only hiccup is that the only thing on the wristband is an ID number. You have to access the database to retrieve the medical information. But that is to ensure the security of the wristband-wearer in all but emergencies.

The other, more innovative part of this wristband is an embedded RFID chip that can be linked to a debit account. In effect, the wristband becomes an e-wallet. Again for security reasons, the e-wallet account is to be capped at $200. Wave the RFID chip in front of a compatible e-reader and your account is debited enough cash to cover your current need (chips and salsa, Gatorade, etc.).

These two elements together add up to a perfect thing for an athlete to carry, especially a person who often trains by himself or herself and/or is sometimes to be found training far from civilization. Common needs for athletes far from civilization are medical help, of course, but also sustenance in the form of food and drink. Many runners, especially, don't make a habit of carrying a wallet or purse with them or a credit card; if they do carry money, mostly, it's small bills, not usually enough to pay for necessary things like a taxi or more than three bottles of Gatorade. (Sometimes, you just really get thirsty.)

This is not to trivialize medical needs because they can be great, especially if you're in the middle of nowhere and you happen to get hit by a car. The medical information on this new wristband will be vital in that case. Thankfully, situations like these are far outweighed by situations involving an athlete's needing to spend money to refuel, without necessarily having the means to do so.

For both of these reasons, sign me up.

Surf's Up on the High Seas? What a Croc!

Not sure if Hang 10 is supposed to be the number of teeth or the decibel level of the roar, but the image of crocodiles surfing a wave has me chuckling — and frightened.

Seems some research recently released by a group of ecologists out of Australia led these scientists to conclude that the saltwater crocodile, one of the worst swimmers ever of creatures who make their home in water, ended up in far-flung places across the Pacific, despite the fact that they originated in Queensland.

Paddling on the board or riding the wave on two legs? Take your pick. I wouldn't be surprised to find some secret video footage showing some croc dudes going vertical on a wave, using their tails as balancing acts and eschewing such things as surfboards and ankle safeguards. In fact, I wouldn't put anything past crocodiles. They've been found to do some mighty impressive things over the years.

So anyway, these scientists got in touch with the family of Steve Irwin, the "Crocodile Hunter" himself, and worked with them on tracking some big-tailed crocs along Australia's Kennedy River — which, like many places in Australia, is a blind sight far away from any other place in Australia. So these scientists dropped sets of sonar transmitters and sound receivers in the river and listened in for an entire year, cataloging the movements of saltwater crocodiles and other water-based wildlife. (Presumably, the fish and other creatures that ended up being food for the crocs were eventually crossed off the list of "things to track.")

What the data showed is that some of these saltwater crocodiles, despite being winded and needing a nap exceeding three-and-a-half days after swimming for just 20 minutes, had moved rather quickly more than 35 miles upstream. A full 8 out of the 27 crocodiles being watched carried on down the river for miles at a time, oblivious to the fact that they didn't have the best swim technique in the world. One rather large beast was found to have traveled 367 miles in less than a month to an entirely new river system. (And that big beast stayed a full seven months before going home — must have had an extended series of "encounters" at the new place.)

Since the scientists were almost positive that the crocs weren't on some sort of anabolic cardiovascular improvement plan, they concluded that the answer had to be surfing.

OK, so technically the crocs were riding on surface currents and letting the water do the talking. Isn't that what surfers do?

You don't see guys or gals on surfboards chowing down on burgers, fries, and shakes, do you? No. Well, you wouldn't see crocs doing it, either, mainly because they don't need to. They can go for months without food or fresh water, so a surf across a vast waterway like the Pacific Ocean isn't out of the realm of the active imagination. Paddle a few times, get up some speed, catch a current, go along for the ride. That's surfing!

These saltwater crocodiles are big fellas and gals as well, so their normal exertions tire them out. Better to rest on the ocean currents than try to swim for it and lose all motivation for carrying on. Come to think of it, that would be my preferred mode of surfing.

John Wooden: Life Coach Extraordinaire; Oh, He Won Some Basketball Games, Too

John Wooden retired from coaching basketball many years ago. The effects of his tenure at the helm of the UCLA men's program are still being felt, not only in Westwood but also right round the sport.

Yes, he was a winner, if by definition you mean his teams' having won more games than they lost. Yes, he was a winner, if by definition you mean his teams' having won 10 national championships in 12 years (including seven straight). Yes, he was a winner, if his former players went on to become many of the greatest of the pro game.

But the one thing that these players, famous and not, say more than anything else about Coach Wooden is that he taught them to succeed not only on the court but also in life by making themselves better people.

Wooden's famous Pyramid of Success is filled with life lessons and examples of his philosophy, the one that drove him and his players to greatness:

• Have one player on your team that's better than all the rest? Here's what Coach Wooden says: "The star of the team is the team. 'We' supercedes 'me.'"
  
• Think you've found an easy answer? Think again, Coach Wooden says: "Success travels in the company of very hard work. There is no trick, no easy way."
  
• Think some days are less important than other? Coach Wooden didn't: "Perform at your best when your best is required. Your best is required each day."
  

Two of the greatest players in the history of American basketball, Kareem Abdul-Jabbar (left) and Bill Walton, played for Coach Wooden. Both remember him fondly and warmly and emphasize that the winning on the court was secondary to the success that he encouraged them to have as people and as teammates. Abdul-Jabbar (who was Lew Alcindor at UCLA) remembered his coach as having a firm hand and insisting on a hard work ethic and a shared team goal but also being caring and understanding.

Coach Wooden was all about the team, the shared success, the goal-oriented program. One of his three hard-and-fast rules was "no criticizing teammates." His players benefited from the strong work ethic instilled in them by their coach's word and examples. They also benefited later in life by the lessons they learned while pounding the boards of college basketball.

It wasn't just about the ball or the score or the player or the team or the coach. Playing basketball for Coach Wooden was learning how live a better life — better individually and better for those around you. One of the Pyramid of Success's 12 Lessons in leadership is this: "Good values attract good people."

Coach Wooden urged his players to look inward and better themselves and then look outward to their teammates and better the team; only then could the team succeed as a team. ("It takes 10 hands to make a basket.")

One final message from Coach Wooden, in paraphrase and in a direct quote: Be the best person you can be — for you, not for anybody else. Here's what Coach Wooden said (and he said it much better):

"Be more concerned with your character than your reputation, because your character is what you really are, while your reputation is merely what others think you are."

We mourn the passing of Coach John Wooden. He was a man of strong faith, vision, and determination. He valued winning but moreso defined by broad goals like cooperation and achievement of shared goals than by an arbitrary measure such as a scoreboard. He was a lesson to us all that sports performance can be a mirror of players' true selves.

Key to the City: Showing Off the Big Apple

The news out of New York is especially welcome — specifically, that a new public art project has reinstated the panache of offering the key to the city to a dignitary, visiting or otherwise. That practice has been taken over by excess or just plain ignored for too long now. In this case, the dignitaries receiving the keys are none other than the good people of New York City and the keys are gateways to learning more about the city and its sites.

The art project in question is literally titled "The Key to the City" and is the creation of Paul Ramirez Jonas. Rather than giving the literal key to the literal city, the project, a collaboration with a nonprofit entity known as Creative Time, will give a large number of keys to a large number of people and all the keys will be able to open all the locks.

One key will open a hidden closet in the master bedroom of Gracie Mansion, New York's official mayoral residence. Another key will open a concealed door leading to a private exhibition of Faberge jewels at the Brooklyn Museum.

That's the sublime. There's also the fun, as in one key will unlock a box at a Queens ice cream shop and reveal a coupon good for an extra scoop of ice cream for the lucky key-holder.

Dozens of sites are sprinkled throughout the city's five boroughs. Keys will be given out until June 27.

Such a giant key undertaking is nothing new for Jonas, who also gifted the people of Cambridge, Mass., with 5,000 keys that opened up the gate of a city park. All residents got identical keys to symbolize (and, perhaps, reinforce) a sense of joint ownership of the park.

That joint ownership will extend not only to the people who get keys and explore what's behind locked doors but also to the shared experiences that many people will have getting to see the wide variety of special attractions that the Big Apple has to offer. The key to the city, it could be argued, is for its residents to want to continue to live in it and show it off and for its visitors to want to continue to come back and see the sites therein.

Wrong Directions Not a Reason to Sue Google

If this lawsuit is successful, I fear for the precedent-setting level of personal and collective responsibility that would result.

Seems a California woman went to Utah, wasn't sure where she was going and so called up Google Maps on her smartphone, followed the directions, and got hit by a car.

The woman sustained serious injuries, to be sure. No one is arguing that. She was and is surely in a lot of pain. No one is arguing that. She has every right to file a lawsuit against the driver of the vehicle that hit her. No one is arguing that, either.

But just because Google Maps told her to walk on a rural highway … come on, let's be real here. She (or, more accurately, the one or more attorneys who represent her) has included Google in the lawsuit because Google has deep pockets and because doing so would make a great headline in the news.

Park City, Utah, and its surrounding area — the scene of the incident — include rural areas, to be sure, as do most cities and towns. It just so happens that the woman followed the Google directions that told her to walk on Deer Valley Drive, also known as Utah State Route 224. Now those last three words and that three-digit number should have been her first clue that she was entering an area of potentially higher-risk than if she were walking on the streets of Park City. (That's an assumption, by the way, that cars would be traveling at higher speeds in rural areas than in the central business district of a city.)

So she should have been on her guard, to be sure. But she was following directions, so there she was. And she was walking on a rural highway, on which was also traveling the car that hit her. So end of story, right?

Well, no. According to the woman and her attorney(s), it wasn't so much a Car vs. Pedestrian as it was Pedestrian vs. Car and the fine directions-dispensers at Google.

Surely this woman has no standing to sue Google. Surely the judge won't allow that part of the lawsuit to proceed. I'm holding my breath.