Almost 20 years ago, Dr. Lars Aanning lied while giving testimony as a witness in a medical malpractice trial. The jury ultimately sided in favour of his colleague, and ever since then, he has felt haunted by his action.

Dr. Lars Aanning had been called to the stand to provide a testimony, for or against his colleague. The case in concern was a patient that has suffered a stroke and permanent disability after an operation. He had initially questioned his colleague skills; as other patients too have suffered injuries after his colleague’s procedures – but decided to testify otherwise.

Doctors do not squeal on doctors

In that, Aanning understood fully why he was chosen to testify: Doctors do not rat on doctors.

The key question was: “Did Aanning know of any time his partner's work had been substandard?” His reply was a simple denial.

Recently, in a shocking revelation, Aanning now admits that he had lied, but not with any ulterior motives. His reasoning for lying was simple. He lied due to the healthcare sector’s culture of framing attorneys all as threats, and that medical professionals should always protect other medical practitioners against the wrath of lawyers.

The culture was not the only reason. He was also faced with immense pressure. Despite the American Medical Association and the American College of Surgeon’s position that doctors must always be a patient advocate no matter what, he states that doctors would be ostracised should they speak out against their colleagues.

Work culture and peer pressure among doctors

The damage done to this date remains unclear, and the degree at which he swayed the jury’s decision can never be known. What is clear, is that he has been haunted by his decision ever since. Aanning is now an outspoken patient advocate and now assists the same attorney who represented the patient where he lied to protect his partner.

Aanning decided to reveal the truth as an example that a healthcare provider’s words are not 100% foolproof. He also believes that the courtroom is not the right avenue to seek justice for what has happened is the medical arena, where he compared such practices as “mixing oil and water.”

However, there is currently insufficient research to show how often doctors lie to protect their fellow colleagues, and that patients are frequently lied to when they come to harm. Part of the reason is the culture of the fear of retaliation should healthcare professions speak out against their colleague, according to doctor’s and nurse’s statements. His case is certainly not the only isolated case of medical malpractices.

Case in hand: Widower sues against untold of risks of liposuction

In Singapore, a Madam Yeong, then 44, underwent a liposuction procedure that turned out horribly wrong. She collapsed 30 minutes after the operation’s conclusion, and passed away. The cause of death was due to pulmonary fat embolism, and ruled a “misadventure” by the State Coroner.

Her widower, Mr Seto, is now suing and seeking damages from the surgeon who performed the operation, the medical holding company that acted as the collection agent, and the company that had ownership of the clinic.

Mr Seto also alleges that the operation was intentionally or unintentionally performed in such a manner that caused the introduction of a high volume of fat into her blood circulation system, a precursor to pulmonary fat embolism.

In the unnamed surgeon’s defence, it was refuted that the patient had been advised on the risks and alternatives a month prior to the operation. Assessments were also made to measure her fitness and she came through with a clean bill of health.

In support, associate professor Gilbert Lau, a senior consultant forensic pathologist not associated with the clinic or company that owned the clinic, clarified that liposuction has a known risk fat embolism.

Singapore doctors wary of medical malpractice suits

Singaporean doctors also expressed similar fears towards medical malpractice suits as American doctors. In a move to ease doctors’ fears of frivolous lawsuits, Chief Justice Menon suggested certain measures, including the promotion of mediation as a first-step in settling medical malpractice disputes.

"Medical care is of direct concern to all Singaporeans, and we must avoid a situation where the practice of medicine comes to be adversely affected by the medical practitioner's consciousness of the risks of malpractice liability," he said earlier this year.

It is also proposed for disputes to transition over to a judge-led process over the current adversarial process, and the appointment of medical assessors to aid judges in understanding the cases.

The standing panel of medical assessors would comprise of senior doctors nominated by the Singapore Medical Council. This would be implemented with a list of judges certified to pass judgement in medical litigation cases in the High and State courts.

2014 saw an all-time high of 17.2 per 1000 doctor complains on medical malpractices and negligence to the SMC against doctors. Of the 23 disciplinary inquiries in 2014, two were acquitted, two complaints withdrawn, and two cases are pending appeals to the High Court.

The penalties of the other cases ranged from censures, fines, suspension, or a combination. One doctor’s licence was even revoked the advice of the High Court because her "fitness to practise had been impaired by reason of her mental condition". MIMS

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