Let’s assume all physicians could agree on whether this or that procedure was “defensive medicine”. And then let’s agree that we’ll take the highest estimates for its cost. Even then, it is still less than 10% of the total cost of healthcare.

What “reform” would eliminate it? What reform would significantly reduce it? You can’t say caps on damages because several states have had those for decades and there’s no evidence it worked.

What’s more, where is the evidence all the “defensive medicine” works to reduce claims against you? Why are we talking about something that even if we could define it, you’re not even sure it works to help the problem you’re trying to avoid?

What we DO KNOW decreases your risk of malpractice claims is quantity of time spent with the patient explaining what’s going on. So why don’t you do that? Because you’re not incentivized to do so. You’re paid for your time.

I’d love to observe an ER from a perspective other than patient, but me observing you won’t change whether or not 1) you and all other physicians can agree on what is and is not defensive medicine; 2) whether any of the reforms proposed would actually reduce it; and 3) whether it works at all!

You say malpractice is bigger than one plaintiff one case, but there are, according to WC, over 1 billion patient-physician interactions every year. How many malpractice claims are there out of those 1 billion? Is it possible your fears are out of whack with the actual risk?

Malpractice, however, is where we disagree. It is much greater than one plaintiff – one case… it causes defensive medicine. I know you do not like that term because it cannot be defined or quantified. To us, that kind of thinking is tantamount to the lion wondering while the herd of gazelle scatters when the lion attacks. After it is only one gazelle, one day and one outcome, right?

Matt – I would love to have you come and observe the bobcat rodeo I call my Emergency (wait for it, WC) Department. Might change your perspective a bit.

Actually, if you read my posts, you’ll find exactly the opposite position. I’m begging you physicians to step away from the third party payment model that has us speeding headlong toward nationalized healthcare. That’s why you’re regulated more than any other profession, because you gave the government the power to do it when you take their money. If that’s an incorrect assessment, please, correct me. Don’t get me wrong, for 40 years it’s been quite profitable to take the govt.’s money, resulting in physicians having the highest average pay of any profession by nearly 50%, but those days are going to end as the deficit balloons and costs are looking to be cut.

Tort reform is frustrating not only because you guys are on the wrong side of the issue, but because I see you waste so much lobbying time, money, and effort on something that has a miniscule effect on your lives and healthcare in general when compared to the debacle that the third party payment model has become and where it is taking us.

As for malpractice claims in general, that has little to do with your industry as a whole. It’s one plaintiff and one case, each with individual facts and individual outcomes.

As for the more vs less funding/regulation/govenment intervention question, what I want, or even what the medical profession wants, is moot. We are getting, and will continue to get mandates/regulation without funding. The analogy of car safety airbags is somewhat flawed. An automobile manufacturer can (and does) pass the cost directly to the consumer, with the blessing of the government. In the case of EMTALA, the government expressly forbids this cost being passed, until government criteria is met. So imagine going to an ED with a condition and asking “do you take my insurance”. I cannot tell you until after the medical screening exam is done to a standard the government has set for your presenting condition is met (ie chest pain would get an ECG, CXR, cardiac enzymes, O2, IV, nitro etc) BEFORE I can ask you anything to do with money.

By then, it is too late and the uninsured patient is on the hook for the bill, which often is never paid. In my ED, our payment rate of this group of people is about 10% of billed, and they comprise about 30-40% of our ED population. The insured patient will be out their co-pay, at a minimum.

Right now ED’s across the US are straining to stay open, due in large part to these unfunded mandates. I disagree that “a little dough” to cover the costs would not make a difference. It would be an admission by the government that they are indeed responsible for the financing of their mandates, and may actually keep some ED’s open.

Overall, I would love to see much less intervention by the government. Our leadership has essentially raise the white flag, however. I think the only way to effect change is disgruntled individual docs or small groups going through the court system.

So, Max, a legal question. Is there legal grounds to challenge EMTALA?

Some extra dough to cover screening & stabilizing is not going to cure out health system, nor even the problems facing EDs. EMTALA is just not that big an issue from a policy perspective, and it’s also a policy the public happens to like and expect very much. Directing energy at eliminating EMTALA is like car companies railing against safety regulations — suck it up, we expect you to operate this way. Tell us how we can make it happen.

Hemming and hawing about if you want it or not isn’t a solution, which makes it impossible for those of us outside the industry to take the complaints seriously, it just sounds like groveling for a comparatively small amount of money, like if GM and Ford said they’d be fine if we just subsidized air bags. That’s crazy, and complaining about such small matters creates the impression that your industry is fine.

Universal health care would sure do a lot to pad ED’s bottom lines, is that what you want? We could also fold up private EDs all together and make them operate like police and fire departments, with express state funding and guarantees, how about that?