When a hospital ED closes, it’s no big deal – until it happens to be the only hospital within a 22 mile radius of your home. Residents of the western NY town of Westfield are worried that if their hospital emergency department closes they will have no access to timely care in emergencies and won’t be able to get to other emergency departments during winter snow storms (last year the area got 273 inches of snow). Because there are no paid ambulance services available, there is also an issue whether volunteer EMTs will be able to take 3 hours off from their jobs to transport patients to outlying hospitals. And what happens if there is more than one emergency call at a time?
Another article on how Japan is trying to rain in health care spending. Japanese health care spending amounts to 8% of its gross domestic product – half as much as the US – but at what cost? You’re less likely to have a heart attack in Japan, but if you do have one, you’re twice as likely to die from it. Their system is starting to feel financial strains as more patients live longer and develop “expensive” diseases such as strokes, cancer, and Alzheimer’s disease. Now Japan is looking for answers to its problem. One of the commenters to the article noted that Japan is forcing citizens to “put some skin in the game” by paying up to 30% of their health care bills.
While we’re looking at health care around the world, here’s a blog entry about what a good experience one patient had in a Canadian emergency department. I haven’t seen too many posts like that around the blogosphere.
More than half of all Americans uninsured? According to a study by US Treasury officials, 57% of all Americans were uninsured at some point between the years of 1997 and 2006. President Obama used this statistic in his speech, stating that no one should have to worry about going without health insurance, “and once I sign my health reform plan into law – they won’t.” Remember the lesson from Massachusetts, though – having insurance doesn’t equate to having health care. Insurance doesn’t mean much if no one takes the insurance.
A healthcare WTF moment: NJ pharmacy employers arranged a fake holdup where a masked gunman burst into the pharmacy demanding OxyContin and saying that he had taken a worker hostage. Ha ha. Now they’re getting sued.
Drink the Kool Aid. Even though some argue that defensive medicine “doesn’t exist”, a Reuters poll shows that most people are getting the idea that health care isn’t the only thing that needs to change in this country
- 83% of those surveyed wanted tort reform to be part of any health care reform plan
- 72% of voters think the fear of being sued often changes the way doctors deal with patients
- 67% of voters favored special health courts deciding medical malpractice cases
“And in a stunning indictment of the American legal system,” only 43% of Americans had confidence that a lawsuit “without merit” that was filed against them would be resolved in their favor, and only 30% had confidence the lawsuit would be resolved quickly and efficiently
To be fair, the poll was conducted by an independent firm, but was conducted on behalf of Common Good which advocates tort reform.
Someone needs to pass President Obama a glass of the Kool Aid, though. According to a CBS “60 Minutes” interview, he doesn’t believe that malpractice reform will be effective in curbing costs of medical care.
With medical malpractice, is “honesty the best policy”? The University of Michican health system thinks so. Instead of litigating every malpractice case, it began settling some cases and apologizing up front. By doing so, it decreased the number of yearly claims against the 40 hospital system from 262 to 83 in just six years.
I’m not sure that its fair to insinuate that medical providers “lie” when defending a case. Errors occur, but even excellent care can result in a bad outcome. Intuitively, it would appear that having a reputation of settling claims would increase the number of patients making claims. I would like to see whether their “number of claims” statistic also includes the settlements that they have entered into.
Smelling blood in the water? The “sharks” … er, um … plaintiff attorneys are in a feeding … er, um … advertising frenzy lately. Television advertisements for medical malpractice plaintiff law firms rose by 1400% in four years and spending for those ads increased from $3.2 million to $62 million. Why?
But WC, I’ve got all kinds of statistics that show that medical malpractice spending only accounts for .0005% of .000000005% of 1% of total medical spending ever in the entire world, CLEARLY you’re just IN THE POCKET of the MAJOR INSURANCE COMPANIES!!!!!11!!
(It’s amazing how delusional people get in these debates. I was reading a message board where the canonical health-care discussion was going strong; a poster identified himself as a doctor and declared that he practiced defensive medicine all the time. The immediate group consensus was that he was either lying or an idiot, because they all had talked about it a lot and come to the conclusion that defensive medicine didn’t exist…)
****
OKAY. LOOK. YOU DO NOT “REIGN IN” SOMETHING. YOU DON’T GIVE “FREE REIGN” TO ANYTHING. IT’S “REIN”. ARE EEE AYE ENN. OKAY? GET IT? IT’S LIKE A HORSE’S REINS, AND WHEN YOU DROP THE REINS YOU LET THE HORSE RUN ALL OVER, BECAUSE IT HAS “FREE REIN”. AND THEN YOU GRAB THE REINS AND STOP THE HORSE, WHICH IS WHEN YOU “REIN IT IN”. “REIGN” IS WHAT KINGS DO AND IT HAS NOTHING TO DO WITH THE APHORISM. OKAY? JESUS.
Density
I am glad you like statistics. Lets look at them. What is the sensitvity and specificiity you would like in a medical diagnosis to be happy with? lets look at migraine headaches. The clinical diagnosis has a reported sentivity and specificity of 97%. So of course we have false positives, true positives etc. What criteria or statistics are you happy with? I ask this because every pateint who comes into the ED with a bad headache gets a CT. Are these cts defensive? I guess they would not be if you want a 100% value but then again you would also get a MRI, spinal tap etc. So again, where do want the cut off? Here is the problem. The patient comes in with the headache, it is a migraine and goes home. 2 years later you are sued for a posterior fossa astrocytoma that is asymptomatic and find your self sued becuase you did not get the ct years before. The suit is becuase of the emotional trauma the patient had when they found out they had the tumore and the wait for the pathology. So, do we get tests to increase of sensitivity and specificity to a level that society has accepted or do we get tests to a level that trial attorneys have found a way to sue for?
In the meantime I am stuck looking at another ct that was ordered to ward of lawyers. (Medicare paid for it)
…how can you possible have taken my statistics seriously? Do you truly, honestly not recognize hyperbole? I know that it’s fashionable and trendy to have restless-legs syndrome these days, but really: Stop jerking your knee so much.
PS oh whip me, spank me, ‘coz I SHOUTED.
Density:
I was actually trying to see if you would discuss what degree of certainty would be necessary in a medical diagnosis before the testing would be considered “defensive”. Everyone wants to run around the issue, and “knee jerk”, why not discuss it. In your mind, what kind of tests are “defensive”?
@1, kindly refrain from shouting.
It is possible that the text editor White Coat uses to post may not have a grammar checker. Spell checkers don’t flag most English homophones, such as “rain/rein/reign”.
Wouldn’t the tort reformers be the ones drinking the KoolAid since they believe costs will be reduced? We’ve had tort reform for 3 decades – how much cheaper is healthcare in those states than in the states without it.
That should clarify the issue rather quickly.
“a poster identified himself as a doctor and declared that he practiced defensive medicine all the time.”
That’s great anonymously. But until you go on record, it doesn’t mean much. If a med mal lawyer claimed that he never filed a frivolous case, what would docs say? At the nicest, they’d say “let’s see the medical records from your cases.”
“To be fair, the poll was conducted by an independent firm, but was conducted on behalf of Common Good which advocates tort reform.”
Saying Common Good “advocates tort reform” is like saying MoveOn.org backs Democratic candidates. Common Good was set up by the tobacco industry and exists for the sole purpose of making it harder for individuals to sue corporate America. Although they’re not particularly dedicated to reducing corporate America’s ability to sue individuals.
Howard’s firm, Covington & Burling, is also AG Eric Holder’s firm. By this logic, I expect less DOJ scrutiny of Big Tobacco.
It will be interesting to see. Although since Howard actually represented the tobacco industry, as opposed to just working in a firm where they were a client like Holder, it may not have as much direct sway. But it certainly won’t hurt the industry to have their lead lobbying firm so well connected. That’s one of the main reasons companies hire those big lobbying firms.
“Intuitively, it would appear that having a reputation of settling claims would increase the number of patients making claims. ”
According to many physicians, all one needs to do to get a claim settled is be slightly sympathetic and the insurer starts writing checks. So which is it? Does it depend on which statistic you’re combating?
Incidentally, Obama’s plan makes tort reform moot. When you have no concern about the cost of past and future care, you reduce malpractice claims significantly. Especially from those without employment. At that point, you’re just worried about those with significant income from working. Kids, elderly, working women, those screwed most by tort reform benefit from Obama’s plan significantly in that respect.
Since polls seem to make the case, here’s a poll for you. According to this one, more than 1/2 of all doctors support universal healthcare:
http://www.reuters.com/article/healthNews/idUSN3143203520080331
No word on who sponsored it, maybe the Institute for Legal Reform who did such a fine job studying the spending of plaintiff’s lawyers (they wouldn’t mislead, would they? Lobbyists? Perish the thought!). But hey, it’s a poll, and those polled are doctors, so “drink the KoolAid!” Universal healthcare here we come now that the docs want it!
The doctors who voted that they want universal healthcare must not have ever worked at a VA at least if they are thinking of the care they want for their own care. Or perhaps they have worked at the VA and like how it shield them from lawsuits.
Here is the big picture. We cant afford all the medical care that people want, and we cant afford the trial lawyer industry. So, economically, how does the trial lawyer industry justify its existence and how much of the GDP is it worth?
The “trial lawyer industry” does not cost the medical system anything. A malpractice lawsuit does not create new costs it simply allocates existing damages to the responsible party. Now it does cost the insurance industry but that industry is based on assessing risk and paying out when it’s insureds are negligent. That’s why it exists. Now maybe you take the position they should never pay out, I don’t know. But any savings in that industry doesn’t mean savings in the cost of healthcare.
Yes, I know you’re going to scream defensive medicine and we need caps to reduce it. But there’s no evidence tort reform saves the system money even after having it 30 years.
I wonder what planet this President has been living on, where medical malpractice fears have no impact on the practice of medicine. Wherever it is, this planet is the hotbed of all victimhood and whining. Nothing “bad” ever just occurs from rotten DNA or fate–it HAS to be a doctor’s fault, doncha know?
And I totally agree that if a doc is dealing with a normal human being and not a malingerer looking for the Golden Ticket, that honesty IS the best policy. During a hysterectomy my bladder was nicked, needing a urologist in the OR and a Foley for six weeks. My doc brought a cup of coffee and sat down with me as soon as I was lucid and fessed up. The GYN practice covered the Urologist’s fees and follow-up as a matter of course, and we all chalked it up to “shit happens”. Litigation never crossed my mind…but my doc knew enough about me to assume this would be the case. Does anyone READ the damned consents—all medical procedures have risks, and not all complications are malpractice.
Something similar happened to my friend who’s a gyn. The women she was operating on had Crohn’s and had had multiple past surgeries. She nicked the ureter because of all the adhesions, and she had talked about that risk with the patient beforehand. Urology was called into the OR to fix it right away, and she told the patient as soon as the patient was awake, but the patient successfully sued. An added tragedy was that this gyn had just lost her malpractice insurance (she had never been sued; it was a paperwork snafu that left her unknowingly uncovered for about a month). She had to settle for ‘only’ $200,000, taking out a second mortgage on her house because she couldn’t afford the court costs to defend the suit.
She has since retired and stated that practicing isn’t worth the risk.
That’s funny, I recently saw a case where a surgeon performed a tubal on a woman without her consent, and didn’t even bother to mention it in the record.
We should make decisions based on anecdotes. So let’s get malpractice “reform” because of the two cases you guys cited, and let’s put doctors in jail. because of the one I saw. Fair enough? I saw the records in the case I’m referring to – are you two sure you know all the facts in the ones you’re talking about?
Matt:
Why dont we make malpractice the same for physicians as it is for attorneys?
What do you think the difference is?
Question for you. Do you believe there are too many malpractice lawsuits? If so, how many are there and how many would you expect there to be based on the number of patient-physician encounters each year?
WhiteCoat -
I don’t know if you read Andrew Sullivan, but he’s been covering the tort reform issue extensively over the past week, with many expert legal opinions, stats, and economists writing in. He is a prolific blogger, so you’ll have to sort back through his posts to find them all. Sadly, he doesn’t use post tags.
But it’s been an interesting conversation, and if you are passionate about tort reform being included in the healthcare bill, you ought to read it.
You wrote, “83% of those surveyed wanted tort reform to be part of any health care reform plan.”
Here’s the question they asked:
“DO YOU AGREE OR DISAGREE WITH THIS STATEMENT: As part of any health care reform plan, Congress needs to change the medical malpractice system so that cases are resolved quicker, and more reliably, on behalf of those who are in the right.”
I agree with that, too. Doesn’t mean I favor tort reform.
The “independent” firm just conducts the polling itself; the questions are chosen by the sponsor, and manipulated accordingly. It’s quite clear Common Good didn’t want to know how “tort reform” would poll, so they used a meaningless, feel-good statement and then claimed it meant tort reform.