You can simply say that “I’m wrong” and believe it, but it doesn’t make it true. It’s sad that you don’t realize how much you have in common with the rest of society and how if you take the lead on changing your compensation system, the public will follow. As someone who appreciates the value of time, I know I will support you.

You have ansers for everything, and like most who are ignorant of the system, your answers are wrong. I have wasted too much of my valuable time already.

I can only say, I hope that you or your family never have problems for one of the physicians who will soon be practicing in this country, as they likely will not be the highly skilled proffesionals we have now.

That’s great that YOU have disability insurance, but even then the disability carrier may file the claim and pursue subrogation for their losses. The fact is though, that most people cannot afford disability coverage. And I bet your coverage doesn’t provide you to live in the way you do now. All this assumes the insurer doesn’t fight you over whether you’re disabled or not, of course.

” do you think suits would be nearly as common if lawyers worked for a per hourly, and had no financial stake in the verdict.”

I assume you mean personal injury suits, since the vast, vast majority of lawsuits, which are filed by businesses, are paid on an hourly basis. And the answer to your question is no, they wouldn’t. Of course, then the rich would be the only ones who could afford to file suit. Again, assume your debilitating injury – how are you going to pay me $200/hr to sue that driver when you don’t even have earnings to pay your mortgage?

“lets examine a verdict I know about,”

Wait – what’s this mean – one you read all the evidence in or one you heard about from someone? There’s a difference, you know. Give me the name of the case, so I can look it up and confirm – any case with that large a verdict would have been appealed. But again, even if your understanding of the case is right on, that’s one verdict. Should we punish all doctors because one operates on the wrong knee? Determine that the way they practice is a blight on society based on that single case?

As for how much the family saw – the fact is you don’t know, but you’ve formed strong opinions on it. That doesn’t make much sense. But even if you’re right, even if it’s a slam dunk case, how much do you think an insurance company, or the negligent doctor, was offering BEFORE the lawyer got involved? You deal with insurers, right? You know how they work.

“I dont doubt it when you say we will become government employees, I just shudder to think that this is the system that my children will grow up in.”

I agree. But given that physicians have the most at stake, why are they spending so much of your time demonizing lawyers on behalf of their liability carrier, instead of working on an overhaul of your payment method, which would have a much more direct effect on their quality of life and income?

it is called disability insurance, to answer your last point, and no, I dont ascribe saintly morals to insurance companies. But lets examine the point of where the money goes. do you think suits would be nearly as common if lawyers worked for a per hourly, and had no financial stake in the verdict. for that matter, lets examine a verdict I know about, happened to one of my friends. 75 year old male, smoker 55+ years, diabetic and noncompliant with meds, comes in with 4 days of chest pain, diagnosed with an MI in the er, then becomes unstable, goes into vtach and after 30 minutes of resuss, done by the book dies.

Family sues ER physician, family wins 10 MILLION dollar verdict!! where is the justice in that, the virtue. who decides this mans life is worth 10 million, where he basically delayed his care until the terminal event. that ER doc is now selling computers because he does not want to be part of that system again. This is not uncommon.. i bet the family saw les than half of that.

the fact is, if you want quality physicians, just like anything else, you are going to have to pay for them,a nd give them a good work environment,. I have traveled overseas, lived with socialised medicine. you DONT get the best and brightest,a nd you DONT have the care we have here.

I dont doubt it when you say we will become government employees, I just shudder to think that this is the system that my children will grow up in.

Steve

Other people have already pointed out at least one counterexample to this: the drunk who isn’t injured right now, but gets injured later. The test does nothing to improve his health. All it does is give the doctor legal cover.

Tests have costs. If a test has a 1 in 200 test of uncovering a minor defect but statistically will cause 1% of people who receive it to get a fatal cancer, then we have a procedure that should not be done. But with lawyers running the madhouse, the procedure is done, because no one can be sued for the stochastic cancer.

To go for one example: tPA. tPA is a tricky medication. Liability is rare and usually comes from a physician blithely administering it without doing any sort of assessment for the risks.

Back on your main point: “So the corollary of your point is that if a physician *doesn’t* “worry about his own liability,” then the risk isn’t there, the physician shouldn’t “check for it,” and the physician shouldn’t be sued. Is that correct?”

In some sense, that’s true, since liability follows harm. If you’re not worried about liability, it’s because you’re not worried about patient harm. The question then is if you should be worried.

The core point again is: if you’re reasonably worried about liability, it’s because you’re reasonably worried about patient harm, so you should either do the test or at least weigh the costs/benefits of the test and present it to the patient.

Couple of notes. One, you’ve taken a couple of verdicts, which you clearly don’t even know the facts of (the Samaritan case did not involve a building at all) and decided to apply them to a group of people as a whole. The vast majority of whom will never represent a plaintiff in their life. They do wills, trusts, help companies close deals, are public defenders, prosecutors, real estate lawyers, etc. Just because you don’t know about them doesn’t mean they don’t exist. That’s like me condemning all physicians because of the one I know who tied a woman’s tubes without her consent because she didn’t think the woman needed to have more kids. You accuse me of not understanding a complex profession, yet your position is based on two cases you know little about!

As for a system where we let physicians decide the value of a case, do we really need foxes guarding the henhouses? Why don’t we let insurance adjusters decide the cases where physicians sue health insurers for failing to reimburse? Sound like a good idea?

You say we don’t have enough specialists – where? Rural areas where we’ve never had them because they can’t make as much money? And what kind of protection will it take to get them back? Cali has draconian tort reform – do they have all they need?

You need to check your facts on these “good IT jobs or 9 to 5 in an investment office.” Citigroup has laid off tens of thousands. How many doctors are getting laid off. Physicians are in large part insulated from the economy, but I guess the grass always seems greener.

Thanks for the sorrow and pity, but it’s not necessary. I see exactly what’s going on. Physicians have committed themselves to an unsustainable payment system, and are now faced with becoming govt. employees. Rather than work to reform that, they prefer to blame lawyers for their problems. If that continues and we get universal healthcare, it is you who will need the pity.

Question for you though – if you were to get run down by a drunk truck driver, and ends up with a lifetime debilitating injury, who are you going to call to help you get the money it’s going to take for your family to survive? You think insurance companies just write big checks because they feel bad?

Now you’ve reverted to saying that our “training, experience, and judgment” should be the determinants of whether or not testing should be done and, apparently whether liability should ensue.

So if one physician does one thing based on his “training, experience, and judgment” and another physician does something else based on her “training, experience, and judgment” – then how can you hold one physician liable over the other? The facts are that physicians can be successfully sued for doing one thing and for doing just the opposite thing (example: tPA use in strokes). Therefore, “training, experience, and judgment” becomes irrelevant – they do whatever they can to avoid being sued.

“If, in applying that training, experience and judgment you feel there’s a risk likely enough that it causes you to worry about your own liability, then the risk is likely enough that you should, as a matter of good medicine, check for it.”

So the corollary of your point is that if a physician *doesn’t* “worry about his own liability,” then the risk isn’t there, the physician shouldn’t “check for it,” and the physician shouldn’t be sued. Is that correct?

And the “ultra-worried” physician who does MRIs on every headache “just in case” is practicing appropriate medicine. Is that correct?

It’s a deliberately unfair question — have you ever had a patient with simply “headache” or “chest pain?”

Of course not. You’ve had patients with ages, genders, basic histories, current medications, prior related conditions, and severity of symptoms.

As a matter of liability — just as a matter of peer review — you’re judged by what you do in light of the whole picture of the patient.

If you chose to ignore all of those facts and consider the patient as “headache” without taking any history to determine if, say, the patient was on coumadin and recently had a fall, then you will rightly be judged negligent for failing to take the very first step every physician must take, the patient history.

So neither I nor you can answer what you do with just “chest pain.” How old? Prior MI? Medications? How long have they had the pain? How severe is it? Are they having trouble breathing?

There’s a reason we pay YOU instead of a computer to evaluate people in the ER — because you’re supposed to apply your training, experience and judgment to figure out what’s wrong with the patient.

My point is a very simple one: if, in applying that training, experience and judgment you feel there’s a risk likely enough that it causes you to worry about your own liability, then the risk is likely enough that you should, as a matter of good medicine, check for it.

That’s why I say defensive medicine doesn’t exist: the concept requires a doctor be worried about liability but NOT the patient’s health. How can that be? The doctor’s liability is inextricably tied to the patient’s health — no damages, no liability.

You earlier proposed a “1 in 200″ rule. Then you tell me — when a patient comes in with chest pain, what should a physician look for to ensure the patient’s below 1 in 200?