WhiteCoat

Healthcare Update – 02-18-2010

See also the satellite edition of this Healthcare Update with more links over at ER Stories.

“The health reform bill sucks. Just start over.”
57% of Americans

“Rare” multimillion dollar medical malpractice awards in the news …
Minnesota jury awards plaintiff born with cerebral palsy a record $23 million – more than double the previous state record.
In other news, hospital CEO decides to hand hospital keys to attorney after verdict is read.
Two other patients born with cerebral palsy awarded verdicts of $43.5 million and $77 million respectively.
Arizona neurosurgeon found liable for $16.5 million
after delaying evaluation of patient who “jolted his back” while riding a 4 wheeler and ended up paralyzed.

Law firm of Morelli Ratner allegedly “botches” handling of medical malpractice case, gets successfully sued for legal malpractice, then legal malpractice suit gets overturned on appeal. Now law firm is suing its former client to get back $6000 in fees that it fronted for the medical malpractice case. No mention of a retainer agreement where the client agreed to pay for such fees. A New York City judge blasted the firm for bringing “wasteful” litigation and sanctioned the firm for $6000. Next step? Back to appeals court for more wasteful litigation about the judge’s sanctions for engaging in wasteful litigation.
Don’t worry, though. It really has nothing to do with the money. All about doing what’s right for the client and protecting patients, you know.

Patient dies in emergency department waiting room 11 minutes after arriving with left side pain. He was called by the triage nurse 3 minutes later. Hospital is being investigated by the Department of Health. The attorney representing the family made the following statement in a hallway outside the hearing: “When you go to an emergency room, it’s not like going to a bakery.” You’re right. I haven’t heard of many multimillion dollar judgments against a bakery, have you?

emergency_graphi_448685artw

Would this patient still be alive if it weren’t for emergency department closures? An 18 year old Ontario woman was seriously injured when her car was broadsided by another vehicle in snowy weather. The closest hospital had closed its emergency department, forcing the ambulance to travel twice as long to the next closest emergency department (see map to the right). The patient died just before arriving at the hospital.

Don’t have an emergency medical problem in Los Angeles. County supervisors decided to drop reimbursement from 27% of estimated fees at private hospitals to 18% of estimated fees for emergency physicians and on-call specialists beginning in July. Come on, you Los Angeles supervisors, where are your gonads? Just pass another referendum forcing the private physicians to work for free so no one will take care of the patients, the private hospitals will all close their emergency departments and open acute care centers, and the patients with emergencies will all pile into county hospitals and die waiting for care because the county emergency departments will all be overwhelmed. Think of all the money you’ll save.
If I were an emergency physician in California, I’d be looking for a job in another state.

They were medical training videos. Really. Emergency physician accused of storing kiddie porn on his computer.

Four year old child dies, but is it from pneumonia or from an overdose of clonidine? Prosecutors argued that the child’s blood levels of the clonidine were “toxic”, but the defense attorneys noted that the levels were far lower than any of the other reported cases in which clonidine caused child fatalities. The defense team alleged that the child died from pneumonia but the prosecution’s expert stated that “Four-year-old children, as a rule, don’t die of pneumonia.”
I still have issues with prescribing kids clonidine for ADHD. And I have bigger issues with doctors diagnosing 2 year olds with bipolar disorder and ADHD.

Three for one? Washington State Medicare services undertakes plan to move nursing home residents to “adult day care” centers as the adult day care is one third the cost of nursing home care. This Seattle Times article describes the story of one patient who has bounced through multiple nursing homes, day care centers, and hospitals. If care at the day care centers is less than available at nursing homes and patients require repeated emergency department trips and hospitalizations for worsening of their medical problems, does the state end up saving money or losing money?

More tort reform propoganda. Doctors cut back work hours by 1.7 hours per week when medical liability risk increases by 10%. Do these statistics mean that when liabilty risk increases by 200%, everyone quits medicine?


More on New Jersey’s projected doctor shortage. Those attending a  press conference about the release of a report by the New Jersey Council on Teaching Hospitals learned how the morale problem with the state’s physicians was predicted to affect care.
“If nothing changes regarding the state’s “hostile” reputation, people will wait longer to get doctors’ appointments. They also can expect to travel further to find a specialist, and the state will hemorrhage vital jobs medical practices generate” according to members of the Physician Workforce Task Force that spent two years compiling the report.

58 Responses to “Healthcare Update – 02-18-2010”

  1. [...] entertain you with commentary and medical news stories from around the web. There are some additional stories on my blog if you’re [...]

  2. Matt says:

    Let’s just go to single payer already so these physicians can get away from worrying about the law.

    “Don’t worry, though. It really has nothing to do with the money. All about doing what’s right for the client and protecting patients, you know.”

    Don’t you ever get tired of saying things like this? The whole medical system, and your belief in tort reform, is about the money. You’re no different than those you would deride. No one thinks otherwise. The whole healthcare system is now about the money.

  3. SeaSpray says:

    Being a Jersey Girl ..your last link (NJ Doctor shortage/hemorrhage vital jobs medical practices generate)is disturbing.

  4. Matt says:

    I’m confused. New Jersey has a shortage? WC told me the LACK of caps causes a shortage – remember, he said all the Illinois physicians were going somewhere else when their caps got struck down.

    But New Jersey HAS caps. As does California. And now physicians are threatening shortages there? Over cuts in their pay? Egads! Is it really about the money for physicians? Perish the thought!

    This can’t be true. I’ve been told repeatedly by physicians that caps are the key to access. Not more money in their pockets. Caps. Give them damage caps and we’ll have more neurosurgeons than we can shake a stick at they say. Surely they wouldn’t lie to me, would they?

    • throckmorton says:

      Matt:

      The is another reason for the physician shortage in NJ. A general surgeon in NJ with no incidents will pay around $200,000 in medmal insurance a year depending on the county and type of practice (vasculare, etc). This is on top of the office overhead, etc. The reimbursement in the state is decreasing. It becomes simple economics. You cant afford to see self pay and government insurance and still pay your medmal and stay in business. So, physicians have to limit what patients they take. The result, if you have Medicaid, you are out of luck.

    • Matt says:

      Throck,

      I’ll need a source for an average of $200K a year in med mal insurance. And, I’d also have to know a little more about the income. Physicians always want to share their expenses, but rarely their income.

      Again, though, you’re telling me things I agree with when it comes to the economics. But when you’re selling caps, your ilk neglects to mention these other factors. It’s simply caps=more physicians. We both know that’s not true. But I appreciate you repudiating your lobbyists a little.

    • Matt says:

      Throck, I think someone has mislead you on the NJ premiums. But if you’re really worried about it, perhaps you should be backing this bill:

      http://ifawebnews.com/2009/12/16/bill-to-cap-medical-malpractice-rates-advances-in-new-jersey/

      And what’s more, why would NJ have such a crisis? What was the point of caps if premiums are still this high? (That’s rhetorical, btw). Apparently not only are you lying to the public with the “benefits”, someone is lying to physicians too!

      • throckmorton says:

        Matt:

        You seem to have a pre-occupation with caps.They are only part of the big picture. I know how much the medmal costs first hand! Simple economics makes sure that for every cost you either have to have and increase in revenue or a decrease in expenses. Revenue is decreasing and expenses are rising.

      • Matt says:

        My friend, I am focused on the reality. And the reality is that is the legislation with regard to malpractice.

        I am also focused on what doctors say the benefits of that legislation are. However, what they say the benefits are never seem to materialize once they’re enacted. So I start looking to see who does benefit, and it’s clearly not patients or physicians.

  5. CholeraJoe says:

    Re: the teen who died being transported to a hospital farther away – not much medical info, but if she had a transected thoracic aorta from a rapid deceleration, a blood transfusion wouldn’t have saved her. 80-85% of people with such an injury do not survive to reach a hospital. Even if she had reached the hospital alive, she might not have made it without cardiovascular surgical intervention which may have been beyond that hospital’s capabilities.

  6. Big Bob says:

    Matt,

    “You’re no different than those you would deride. No one thinks otherwise. The whole healthcare system is now about the money.”

    You’ve never been up at 4 AM with a sick patient, you’ve never had to decide to heparinize an MI or not, and you have never gone back to the hospital at night because you are worried about a patient. I have. You are slimy as can be How condescending of you to make a statement like that. Sure it is about money, doctors work hard and deserve to get paid. But I would save your blanket moral judgements until you have some actual experience with the medical system.

    • Matt says:

      “You’ve never been up at 4 AM with a sick patient, you’ve never had to decide to heparinize an MI or not, and you have never gone back to the hospital at night because you are worried about a patient. I have.”

      You’ve never sat with a woman whose husband beat her in front of her kids and helped her get a restraining order to keep him away. You’ve never sat with a small business owner whose largest buyer refuses to pay as he faces bankruptcy, the loss of his home, his inability to pay for his kids’ college, etc. and helped him make that buyer honor his contract. You’ve never sat with a child as he struggles through his parents’ divorce being pulled both ways and used for leverage.

      “Sure it is about money, doctors work hard and deserve to get paid.”

      I never said otherwise. Just spare me the sanctimonious nonsense about how lawyers are just in it for the money. You guys would screw every injured patient in sight if you could save a few dollars on your malpractice premiums. So how about we just leave the moral judgments out altogether, and stick with the merits?

      • JustADoc says:

        Actually your 1st and 3rd case I have been involved in. I didn’t work on the restraining order but I did tend to the injuries and help get her into a battered women’s shelter and then see her several times over the following months dealing with the mental trauma. And I’ve dealt with numerous physical and psychiatric manifestations that were rooted in parental and other home social issues. I cannot recall a specific case of a small business owner struggling because of someone not paying, but I have spent time with many struggling business owners who are on the verge of a mental break.
        And I am by no means alone as a physician. Every FP, internist, peds, ER doc, psychiatrist and probably most other specialists have dealt with someone with some variant of your stories on numerous occassions.
        So we have all of Big Bob’s scenarios, and all of yours. And yes, we’d like to get paid for those encounters. How insenitive and greedy of us.

      • throckmorton says:

        Matt:

        Tort reform is not all about caps. We have a problem her in the US in how our healthcare dollars are spent. Liability is both a cause and an excuse for how that money is spent. We have both a legal and a medical crisis. Both systems are flawed, and their flaws are magnified when they come together.

        We cant make medicine cheaper when the “standard of care” is determined on the exception in court as opposed to true evidence based studies. Until we find a way out of this mess, both systems are making the patients suffer. To fix it there has to be reform. So, I propose the use of evidence based studies to determine the proper pathways for patient treatment. What do you propose to fix our legal system?

      • Matt says:

        JustaDoc, if you’ll notice my post was in response to a statement by WC. Personally I don’t care one way or another how much physicians make. If that’s what the market thinks you’re worth, it’s no business of mine. Just don’t go calling everyone else greedy.

      • Matt says:

        “Tort reform is not all about caps”

        My friend, you may believe that, but I would challenge you to find a legislative proposal with any traction that does not have them. You will not. So you can believe that if you want, but the evidence says otherwise.

        “We have both a legal and a medical crisis. Both systems are flawed, and their flaws are magnified when they come together.”

        Statements like this mean little. One, you assume perfection exists somewhere. Two, you give us no metric to judge success by. Three, you’re wrong. Our healthcare system delivers quality care to hundreds of millions of people in a relatively timely, efficient manner. Our legal system adjudicated millions of disputes on a daily basis in a nonbiased manner. Now, one can take either system and find an example of something gone wrong. That’s true with all human endeavors. But the vast, vast majority of it works.

        “Until we find a way out of this mess, both systems are making the patients suffer.”

        Again, this is a blanket statement which sounds good but means little. First, you fail to define the “mess”, second, you fail to define what you consider suffering. And third and most importantly, you fail to define what would constitute success. How can anyone address that?

      • throckmorton says:

        Matt:

        I am sorry that you will not participate in a discussion about improvement in our medical and legal systems. Our systems are flawed and it is our responsibility to fix them. They are not perfect, nor will they ever be but we should attempt to get them as close as possible. Yes, there are little legislative measure that have traction, that is because they are being fought by those who are to proffit in the present system.

        We can be part of the problem of the problem or part of the solution. What part are you?

      • Matt says:

        “I am sorry that you will not participate in a discussion about improvement in our medical and legal systems. Our systems are flawed and it is our responsibility to fix them.”

        Until you define what you think the flaws are, it’s difficult to address solutions. However, I think you’ll find that my solutions are consistent – less government and more individual freedom. Your solutions appear to be less government in one, and MORE bureaucracy in another.

        I think you’ll also find that physicians, while they talk a good game, are ultimately unwilling to give up the golden goose of third party payors and enter the free market.

        If you’re looking for solutions, my solution will always be maximum freedom to the individual. Now, I recognize there is a certain limit that none of us can pay out of pocket in a timely manner for emergency unexpected care. So I have no problem with catastrophic care above a certain dollar figure. I expect you’d find that all kinds of financing options (both legit and nonlegit) would pop up for medical care in that event.

        As to legal changes, I would reduce the federalization of state law issues. I would scale back the narrow statutory causes of action and allow the traditional common law to fill the void. As for your goal of reducing the power of the jury, we will not find common ground. Again, I believe in the REDUCTION of government, and the MAXIMIZATION of individual freedom. Further government intrusion into the jury system, particularly based solely on thin anecdotal evidence, is not consistent with those beliefs.

        “Yes, there are little legislative measure that have traction, that is because they are being fought by those who are to proffit in the present system.”

        Point me to one of these legislative measures you’re talking about that you believe in. I’ve yet to see them.

      • Matt says:

        “So we have all of Big Bob’s scenarios, and all of yours. And yes, we’d like to get paid for those encounters. How insenitive and greedy of us.”

        Never said you didn’t deserve to get paid. I simply don’t want to hear the nonsense about how everyone else is in it for the money but you.

        We’re all dealing with different parts of the same lives, and often the services offered by medical professionals and those offered by legal professionals overlap in the same person. That’s why it makes little sense to be at each other’s throat in the political agenda. Particularly when, at least for physicians, they’re really only acting as the attack dogs for insurers. There’s no actual benefit to the physician, as New Jersey, California, etc. show.

  7. Sarah says:

    CholeraJoe you are absolutely right. I grew up in Fort Erie and the ER there has always been a joke – no specialists, no diagnostic imaging (well, X-ray and ultrasound during the day…).

    When my grandfather had his heart attack, he wasn’t seen by a cardiologist until 5 days later – when his heart collapsed and he had to be air lifted to a larger centre over an hour away. How do you call yourself an ER when you have no access to any specialists… At all? Why bother diverting an ambulance to a centre that can’t treat the patient? If this girl had been taken to FE she would have died there and there would now be calls for an inquest into why she was taken to an ER that couldn’t treat her.

    Fort Erie has always been an urgent care centre, it’s just that now they’re actually treating it like one.

  8. Dave says:

    I just have a few comments.

    First, if it were all about the money, no physician would see medicaid patients, as the reimbursement is less than the cost of seeing them, and few primary care physicians would see medicare patients, where the reimbursement is slim enough to be not worth it. When news reports are that the Mayo clinic in Arizona is balking at seeing medicare patients you know there’s a problem. Kudos to all the MD’s who see these folks, because I know it isn’t for the money. Kudos also to all MD’s who take service call, where they care for indigent patients with no hope of getting reimbursed. At my local hospital that’s 16% of the population – almost a day of work a week for free for the hospital as a whole. (I know there’s cost shifting – that’s not the point).
    For a lot of people the health care system works fine but for many it’s unavailable or awful. But I can’t see how anyone can defend our current malpractice system. Most patients who are injured do not get reimbursed, a lot of suits are filed with no malpractice having occurred, or are filed against every individual who has a name on the chart, whether or not they had anything to do with the supposed mistake. If a plaintifff does win a suit it takes years and is very expensive. It’s emotionally traumatic for both physicians and patients. Many suits are filed for bad outcomes, which is built into a lot of current medical care – an example being TPA for strokes, which helps one in three patients who receive it and injures or kills one out of twenty or thirty who get it, but no one knows what will happen when the infusion is started. Also, should the patient be compensated if the outcome is poor even though the protocols were followed? The current system does encourage expensive defensive testing and unnecessary referrals to specialists – nobody ever got sued for referring to a specialist, and then the burden’s off the referring MD. Hard to think of a more dysfuctional system than this. We really should come up with something better.

    • Matt says:

      Almost all of that with respect to the problems with malpractice is so true. So when someone comes up with some legislation that pays more patients injured by negligence faster, and at less cost to them, I will back it 100%! However, as long as physicians’ liability carriers are running the show, the chances of that are exactly 0%. They have no interest in paying more people sooner, and neither do most of their insured physicians.

      • throckmorton says:

        I think there can be agreement that people who are injured as a result of malpractice should be compensated. The problem is “what is malpractice”. What I and my collegues fear is being run through the ringer for a bad outcome when everything has been done appropriately. We need a better understanding and definition of what exactly is malpractice. A good way of doing this is allowing the medical boards of the specialties to have their guidelines be used as a basis for the standard. We also need to use evidence based studies to show what tests, procedures and follow up are necessary. We need these studies to hold up in court so that they are passed on to our medical students and residents to reverse the trend of test, test, test, to cya, cya, cya.

        As to liabilty carriers running the show. For most of us, these are mutuals, that is to say, we are the insurance companies.

      • Matt says:

        Throck,

        What you call “run through the ringer” is something you’re going to dislike no matter what. It’s a process where you have to answer written and oral questions under oath. That’s going to exist in any system.

        Now, if you want to define malpractice more clearly for each situation, there is nothing stopping physicians from doing that. After all, YOU set the standard of care. That’s on you to do. So do it. There is literally nothing whatsoever keeping you from putting out those guidelines. Except yourselves.

        The solution to the problem you set forth is yourselves.

  9. Steve says:

    Regarding the waiting room MI…if he died 13 minutes after hitting the door I really doubt that him getting back to a bed and getting an EKG within 10 minutes would have made a difference. No one has mentioned how long it took him to present after his “left side pain” started…I have treated a few patients who would still be alive if they hadn’t wait hours to come to the ER for their chest pain…

    My question is- does the ER physician on duty have any share in the (possible and questionable) liability since his doctor/patient relationship wasn’t established until after he collapsed? In these cases do the doctors on duty get named?

  10. Big Bob says:

    Matt, you are all over the place. I’m getting whiplash reading your comments. I guess you are of the “say a lot of stuff and hope at least one thing makes sense” school of debating.

    • Matt says:

      I’m sorry you are having trouble keeping up. If you need some clarity on something in particular please don’t hesitate to ask.

  11. PJ says:

    Just a note…that “Arizona neurosurgeon” was actually a California neursurgeon according to the article…the injury happened in western AZ (to an AZ resident) who was flown to a CA hospital where the neurosurgeon allegedly didn’t come in within the prescribed timeframes.

  12. Dave says:

    I cant think of a single doctor who is against a sweeping reform of the current malpractice system, and I suspect the insurance companies feel the same way. Caps on noneconomic damages are a small part of the problem. Doctors feel that the current system is a crapshoot. You can be sued when you’ve done nothing wrong, sued if you were very peripherally involved and had nothing to do with the mistake, and can lose your livelihood and reputation over this. I know of no other profession where a person can perform perfectly and still wind up with an awful mess – my previous TPA comment is an example. We also know that if only perfect people practiced medicine or nursing there would be no doctors or nurses, and the complexity of the field is such that despite best (I would say extraordinary) effort, it still will occasionally happen. Everyone, including the best people, occasionally misses stuff. Patients should be compensated for this when it happens, but good providers should not be devastated in the process, and patients should be compensated justly, not turned into multimillionaires. Lawyers should not get a third of the windfall – that’s crazy. Most of the money should go to the patient. And yes, we need a system that identifies poor providers. That’s a whole separate topic.

    As far as the legal profession serving justice, in each case, for every lawyer on one one side seeking “justice” there’s a lawyer on the other side opposing it. I would prefer a system where a board of medical experts determines the merits of a case and an economic expert decides the compensation. Get the current “trial by combat” system abolished. It serves nobody well except the legal profession.

    I was named in one lawsuit in my 30 some years of practice, and later dropped from the suit because I had no significant interaction with the patient, none at all relating to what the suit was about, but my name was on the chart. This hung over my head for three years – recurrent “continuances” on the plaintiff’s attorney’s part. The case was later settled out of court for $10,000 by one of the doctors to get rid of it, and it probably had no merit as he followed clinical guidelines to the letter. This episode, which occurred over 20 years ago, has colored every single interaction I have had with patients since then, has changed the way I view patients (they’re all now potential litigants), and changed the way I practice. I’m not alone in this – ask whitecoat. I do practice defensive medicine and do everything I can to avoid exposure to liability. If you don’t practice this way you’re either a saint or stupid, I’m not sure which.

    It isn’t doctors blocking tort reform.

    • Matt says:

      “And yes, we need a system that identifies poor providers. That’s a whole separate topic.”

      No, it’s not. That’s the deal. If you spent half as much time working on processes that improved your delivery of services, instead of trying to screw the injured, we might not be having this discussion.

      Here’s a crazy suggestion – work on “reforming” the industry you actually understand, medicine. It makes no sense that you physicians have all kinds of thoughts on how the law has got it all wrong, but if I were to ask one of you which of your colleagues is better than the other, you’d clam up in an instant. Even if you’d never let that doctor do a thing on you or yours.

      But no, you can’t be bothered to tell people when there’s a bad physician out there, and you certainly can’t be bothered to testify for the plaintiff when that physician negligently injures a patient.

      But you CAN be bothered to back valuing that patient’s lost quality of life at no more than $250,000, no matter what the injury or how much longer they’ll live. No matter how devastating the injury resulting from the negligence of your colleagues, you think that can’t possibly be worth more than 60% of what a cardiologist makes in ONE YEAR. So spare me your sanctimonious jabbering about how it’s about the patients.

      How about you quit trying to take away Constitutional rights because once every 30 years you get questioned about your actions, even though the chance of you paying a judgment out of your pocket is about equal to the chance of you landing on the moon, and you spend your time weeding out those physicians who you know are likely to hurt a patient.

      • Xhy says:

        Physicians can’t just “work on reforming the industry they actually understand” because they have to keep looking to lawsuits to determine things such as the standard of care.

        The day lawyers stop dictating how physicians should practice via lawsuits anytime there is a bad outcome will be the day physicians stop talking about how the law has got it all wrong.

        Until then, physicians will keep practicing defensive medicine and you can keep pretending how it doesn’t really cost that much (since you refuse to restrict yourself to working on reforming the industry you understand, law).

      • Matt says:

        “because they have to keep looking to lawsuits to determine things such as the standard of care”

        Nonsense. No med mal case goes forward without a physician establishing the standard of care. And I’m willing to bet you’ve never reviewed the evidence in a single case to see if the standard of care was met.

        “Until then, physicians will keep practicing defensive medicine and you can keep pretending how it doesn’t really cost that much.”

        It may cost quite a bit. The thing is, no one knows. You guys have promised that if we do this or that, it will decrease. But we’ve been doing those things for 30 years with no discernible effect in the cost of healthcare or any obvious reduction in “defensive medicine” (however you define it).

      • Xhy says:

        Matt,

        If no lawsuit goes forward without a physician establishing the standard of care, how do you explain Brett’s post below where he was sued and an entire trial taking place despite following the standard of care? Or Dave being named in a suit after treating a patient with a completely unrelated back problem because his name happened to be on the chart? Or how about Dave’s Infectious Disease specialist friend who saves a mans life and gets sued for his effort because he was “told to do so by his lawyer.”

        If you don’t think these events have an effect on the future actions of physicians because in the end the suits weren’t “successful”, you need to take a basic psychology course.

        I don’t know that anyone can promise what will happen in the future if tort reform is enacted, but we absolutely can look at the past to see why physicians behave the way they do today. Perhaps we won’t see any obvious reduction in defensive medicine until a whole new generation of physicians studies, trains, and practices without the fear of a lawsuit directing their decision making.

        Here’s a question I am interested in: Since medical malpractice lawsuits are about protecting patients from physician harm and lawyers have promised that med-mal suits are the only thing stopping incompetent physicians from injuring patients left and right, has there been any discernible effect on patient safety now that any bad outcome is a lotto ticket for a potential jackpot payout? Any data on increased rates of patients being harmed in the states that have greater limits on med-mal suits compared to med-mal “friendly” states? Just wondering.

      • Matt says:

        “If no lawsuit goes forward without a physician establishing the standard of care”

        Apparently another physician disagreed with him. That’s not unusual. In WC’s trial, two physicians hired by him disagreed.

        And let me be clear. The lawsuit can be filed, it just can’t proceed to trial without some physicians being present to state the standard of care.

        As to the other stories you mention, they’re just 1 or 2 sentence summaries, by one of the parties, about cases with mountains of evidence. I’d be irresponsible to comment on them as far as their merit. You’ve heard one side of the issue, and briefly, and you’re inclined to believe that side. However, both parties in a lawsuit almost ALWAYS believe their right. If you hit another car today and you both think the light is green, one of you has to be wrong, but you may well believe it’s not you.

        That being said, again, ANY system for resolving disputes will occasionally bring in people who are subsequently dismissed during the fact gathering stage. You can call that system “Getting ice cream with Playmates”, but there will be people who don’t want to go through the fact gathering stage of getting ice cream with Playmates.

        “Perhaps we won’t see any obvious reduction in defensive medicine until a whole new generation of physicians studies, trains, and practices without the fear of a lawsuit directing their decision making.”

        We’ve had your proposed tort “reform” for 30 years. How long do you need? After all, the proposed “reform” doesn’t stop you from getting sued. It simply arbitrarily caps the value of those injured the worst. Any endeavor has the risk of a lawsuit – ie a dispute resolution process. Physicians sue each other all the time when their partnership agreements fall apart – has that made you guys all solo practitioners? Of course not.

        ” Since medical malpractice lawsuits are about protecting patients from physician harm and lawyers have promised that med-mal suits are the only thing stopping incompetent physicians from injuring patients left and right, has there been any discernible effect on patient safety now that any bad outcome is a lotto ticket for a potential jackpot payout? ”

        Couple of things. One, no person with a med mal verdict feels like they got a “jackpot”. If you have a million dollar verdict you likely have a ton of medical bills. So much of that “jackpot” goes to pay physicians and health insurers. Or, you’re dead, in which case again, it’s no jackpot or lottery. I’d love to win the true lottery, wouldn’t you? Do you really want to win the medical malpractice “lottery”? Want to trade places with any of those “winners”? Didn’t think so.

        Second, medical malpractice lawsuits are not about stopping incompetent physicians or protecting patients. They cannot do that. Only the medical boards can rid us of incompetent physicians. And by the time a lawsuit is filed you can’t “protect” anyone. The damage has been done. A lawsuit’s only purpose is to determine fault, and then determine the value of the damages of that fault. There may be some lawyers who believe that there’s a large deterrent effect, but I’m not one of them. A medical malpractice claim is primarily between the two parties, and that’s it. If for no other reason than the vast majority of malpractice results in no claim at all. Societal change resulting from a suit between two parties is an ancillary, and I believe minimal, effect.

        Not to say that some won’t claim otherwise, though.

    • Max Kennerly says:

      In thirty years, you were named in one lawsuit that was settled by someone else for a nuisance fee.

      How terribly unjust.

      • WhiteCoat says:

        At first I laughed at your comment.

        Then I thought … if it was the doctor screwing up and missing one MI or one case of pediatric meningitis in 30 years, he’d still be on the hook for millions of dollars and would have the case hanging over his head for the rest of his life through the National Practitioner Data Bank.

        What do you think happened to the lawyer for screwing up and filing a frivolous case against this doc?

      • Matt says:

        Still on the hook for millions? Who? The physician himself?

        You say the case filed was “frivolous”, but aren’t you Monday Morning Quarterbacking, the thing you hate the most. That’s a factor of any legal system, in any country, to allow the parties to discover the evidence.

        In this case, the evidence was fully fleshed out, and he was dismissed. ANY system for resolving disputes will do that.

        As to “hanging over his head”, what do you mean? Physicians with multiple judgments still work and earn hundreds of thousands. Heck, physicians with drug abuse problems known to the state medical boards still do. And you’re telling us being named (not paying) in the NPDB is career crippling? Be serious.

  13. Matt says:

    “Doctors feel that the current system is a crapshoot”

    What doctors “feel” doesn’t mean much. Many people feel doctors get paid too much. That tells us nothing.

    ” You can be sued when you’ve done nothing wrong, sued if you were very peripherally involved and had nothing to do with the mistake, and can lose your livelihood and reputation over this.”

    If you don’t want to be sued, offer to give an deposition pre-filing. The reason you are sued is because in order to know all the facts, you have to be compelled to answer questions under oath. You won’t do that without a suit. The reason that you’re brought in even if you’re only peripherally involved is that at the beginning of the case, the plaintiff can’t be sure that you weren’t at fault, as not all the facts are in. They also can’t be sure that after the statute of limitations runs, one of the other defendants won’t start blaming you, knowing you’re judgment proof.

    ” Patients should be compensated for this when it happens, but good providers should not be devastated in the process, and patients should be compensated justly, not turned into multimillionaires. ”

    Can you point me to a patient who received a judgment in the multimillions who you feel was unjustly compensated? Who doesn’t have millions in medical bills? And millions in lost income? You guys talk about these people with large judgments like they’re lucky. Do you know any you would trade places with?

    “. Lawyers should not get a third of the windfall – that’s crazy. Most of the money should go to the patient.”

    How much should they get? You have no idea what is even involved from a work or risk standpoint. How are you in any position to say what two other parties should contract to receive? Should people who have never been a physician get to dictate what you make?

    ” I would prefer a system where a board of medical experts determines the merits of a case and an economic expert decides the compensation. ”

    That’s fine. Let’s just let every industry judge their own. When you sue the guy who built your house because your roof is faulty, the jury should be nothing but contractors. Sound fair?

    “This episode, which occurred over 20 years ago, has colored every single interaction I have had with patients since then, ”

    This is ridiculous. You were named in one suit in thirty years. You were let out before trial. At most, you gave one deposition, and answered some interrogatories. Maybe a week total of your time, and that’s being generous. You’ve probably seen over a million patients in that time. And because you didn’t like the fact that someone dared to question what you did, we need to throw out Constitutional rights? Little dramatic, don’t you think?

    You ever been in a car wreck? Or almost in one? Do you now always drive the speed limit, never get within two car lengths of the car in front of you on the highway, stop for 3 seconds at every stop sign, cruise through a yellow light?

    “It isn’t doctors blocking tort reform.”

    Never said it was. Doctors support caps wholeheartedly. You’ll see them backing them every day. Of course, caps don’t make much sense if you truly care about those injured by negligence.

    • WhiteCoat says:

      Matt, you’re getting into troll territory now.

      “What doctors “feel” doesn’t mean much.”
      That statement is either purposely inflammatory or horribly ignorant.
      When doctors are the ones who provide the care and decide whether or not to practice defensive medicine and decide whether or not they’re going to provide on-call coverage, what they “feel” may mean the difference between getting medical care and not getting medical care. If the closest neurosurgeon or invasive cardiologist “feels” it is to big of a risk to continue practicing in your neighborhood when you have a time-sensitive emergency, those “feelings” could make the difference between life and death.

      “If you don’t want to be sued, offer to give an deposition pre-filing.”
      Kind of tough to do when the first contact most people have with a plaintiff’s attorney is a sheriff knocking at their door and handing them a summons and a complaint.
      Obviously you don’t know legal procedure very well, either.

      “The reason that you’re brought in even if you’re only peripherally involved is that at the beginning of the case, the plaintiff can’t be sure that you weren’t at fault, as not all the facts are in.”
      So basically you’re saying it is OK to file frivolous shotgun lawsuits against anyone whose name appears in the chart without performing any due diligence just so the lawyers can cover their own asses. Isn’t that a twist.

      “Do you know any you would trade places with?”
      When a plaintiff gets an unjust settlement because it’s cheaper to pay off the attorneys than fight the case or when a plaintiff gets an unjust verdict based on junk science testimony from a professional plaintiff’s witness, I’d trade places with each and every one of them. Actually, no I wouldn’t. I have more scruples than that.

      How much should lawyers earn?
      Hmmmm. Let’s set up huge payment bureaucracies called LegaCare and LegaCaid, essentially force lawyers to join them and find out.

      And get off your “malpractice caps” fixation. The one trick pony argument is getting old.
      I think you’d find that a lot of doctors don’t agree with $250,000 caps. And you’ll also find that a lot of legislation doesn’t have caps. The Access to Emergency Medical Services Act being advanced by ACEP doesn’t mention caps. And your “how much is a human life worth” argument is disingenuous. I think a human life is priceless. Let’s give all the wealth in the universe to one family for the death of their loved one and one third of that money to Gerry Spence. Then all the lawyers can file lawsuits against Gerry Spence to see who gets what share of that third. Will that make you happy?

      • Matt says:

        “That statement is either purposely inflammatory or horribly ignorant.”

        It’s neither. It’s simply a fact. Your “feelings” should not be the basis for legislation. Your facts should. If you have any.

        “And get off your “malpractice caps” fixation. The one trick pony argument is getting old.
        I think you’d find that a lot of doctors don’t agree with $250,000 caps.”

        LOVE to do so. Unfortunately, I can’t, because that is the CENTERPIECE OF EVERY SERIOUS PIECE OF LEGISLATION YOU GUYS PROPOSE. Again, that’s a FACT. Not a feeling. See the difference? You physicians may FEEL that they’re a bad idea, but the FACT is that it’s in the bill.

        You want to increase sanctions for frivolous claims? By all means do so. It’s when you want the government to arbitrarily cap the value of a person’s claim that we differ.

        “The Access to Emergency Medical Services Act being advanced by ACEP doesn’t mention caps.”

        You’re right, it doesn’t. Because it deals exclusively with medicine (save the appt of a bipartisan commission to release another study). It does not delve into another arena, such as law. If you think that Act is a good idea, I am inclined to agree with you, because it appears to be physicians focusing on THEIR field. So I will defer to your judgment there.

        “I think a human life is priceless. ”

        Then why do you keep trying to put its value at $250,000?

        “How much should lawyers earn?”

        Whatever the market will bear. I realize this is a foreign concept to a physician, who does not compete on the quality of his skills or the level of service to the patient, but that’s what it should be.

        “When a plaintiff gets an unjust settlement because it’s cheaper to pay off the attorneys than fight the case.”

        Can you please let me know the insurers who routinely settle “unjust” cases? Surely you know, as you make this claim regularly.

        “So basically you’re saying it is OK to file frivolous shotgun lawsuits against anyone whose name appears in the chart without performing any due diligence just so the lawyers can cover their own asses. ”

        You seem incensed by the fact you might have to answer questions under oath. But I have a solution for you. Do you support extending the statute of limitations for medical malpractice two more years (most are 2 year SOLs), and will you consent to answering questions under oath without suit being filed? If so, then we can agree!

  14. Dave says:

    Actually, Matt, I worried about it for the very lengthy time I had it hanging over my head. And the plaintiff didn’t “dare question what I did” because I didn’t do anything concerning his case. I saw him one time for a completely unrelated problem. I saw him one time for low back pain and his suit was about issues regarding a pituitary tumor – But I still got involved because my name was in his chart. As you said, this was to discover my level of involvement. If they had asked me beforehand I would have been happy to tell them, but the suit was the first contact.

    I have a friend who is an ID specialist who was asked to see a very ill patient with mediastinitis, which developed due to a perforation from an upper endoscopy – a risk of the procedure. My friend remained at his patient’s bedside in the ICU LITERALLY around the clock, eventually pulling him through his septic shock. Of course he was named in the ensuing lawsuits. He also was eventually dropped from the case, but only after the chaplain of the hospital (who had become intimately acquainted with the patient during his hospitalization) went to the patient’s home and asked him if it was true that he was suing the man who saved his life. The patient replied that he was told to do so by his lawyer. The clergyman (who later told me of this interaction) informed the plaintiff exactly what he thought of his actions, and on reflection the patient then called the lawyer and told him to drop my friend from the case. Another issue of a doctor being pulled in who had nothing to do with the injury. Face it, the system sucks.
    And as has been pointed out, it’s the FEAR of lawsuits that drives defensive practices. The “feeling” that docs have about the current system contributes to this so it does matter, at least if you want to reduce defensive testing. And yes, I do always drive the speed limit – actually under it on the highways for the gas mileage.
    Your comments are exactly why the current dysfunctional system won’t be changed. The right of a person to sue another in this country is paramount.
    I thought you agreed the current system was flawed. It would be good for everyone if a different, fairer system would develop.

    At one of the hospitals I used to practice in, when I was in private practice, an attempt was made to get one of the surgeons off the staff for incompetence. During the ensuing lawsuits, all the officers of the medical staff and the entire county medical society were sued. Legal fees for the county medical society were 178,000 dollars. I know the sum, as I paid some of this out of pocket as did all the other members of the medical society. The lawsuits filed against the staff were about restraint of trade and therefore sidestepped the surgeon’s competence issues. There was no insurance to cover the medical staff officers or the county medical society if the verdict went in favor of the surgeon, which it did not. One mistake that was made is that the hospital staff was unanimous in its decision to oust the surgeon, thus allowing everyone to be sued. A closed ballot with one dissension would have avoided a lot of grief. That was the last unanimous decision the medical staff ever made. The point being that disciplining poor physicians guarantees legal issues – the right to sue again being paramount in our society.
    Currently in the system I work in, certain triggers will cause a review of a case, which then goes before a peer review committee. In addition, each physician has a certain number of random cases reviewed annually each year. Cases in question are submitted to an outside reviewer. Last year one physician was terminated for poor performance. (Yes, a lawsuit was then filed and then settled – I dont know the sums involved).
    Our system also has a formal written policy of informing patients of mistakes. This is a relatively new development but I think will become more widespread in other systems because it often keeps the ensuing mediation out of the courts. How well it will work – I think too early to tell. Good idea, though.

    You really do stereotype physicians. I personally dont care much about caps, it’s the other flaws of the system that bother me. But I doubt we will find anything to agree on.

    • Matt says:

      “You really do stereotype physicians. I personally dont care much about caps, it’s the other flaws of the system that bother me. But I doubt we will find anything to agree on.”

      I don’t stereotype you at all. I judge you by the bills most of you support in this arena.

      As to the “other flaws” of the system, I think we can both agree that it takes too long and the overhead cost is too much. Neither of those things actually affect the cost of medicine, but they are a problem.

      Of course, to solve those problems one would have to propose a bill that makes it easier and less costly for more people to make claims when they’re injured. I’m unaware of any physicians, and especially any physicians’ liability carriers, that want to do that.

      Outside of their efforts to gut the jury system in favor of their liability carriers, I have the utmost respect for all physicians, and indeed all professions. I am, admittedly, confused as to why physicians spend so much time trying to reform the legal system, which most barely understand (especially WC), rather than their own payment model. It would seem that the latter would have far more effect on their lives.

    • Matt says:

      “The point being that disciplining poor physicians guarantees legal issues – the right to sue again being paramount in our society.”

      And yet, other professions do it all the time. Now you’re even blaming others for your inability to police your own? When do physicians take responsibility for anything?

  15. Dave says:

    A few more details on my own case and then I’m out of here.

    The patient involved was a young man who presented to one of my partners for migraines, present for years and classic – aura, unliateral, throbbing, brought on by certan food, the whole nine yards. His neuro exam was normal. Recommedations and guidelines for this scenario specifically recommend AGAINST getting a head CT scan. He was treated with propranolol for prophylaxis and the headaches resolved. I saw the patient a year later for an acute back sprain – no mention was made of headaches. A year after that he developed some visual problems and was found to have a pituitary tumor. The lawsuit was filed against my group for delay in diagnosis, stating he should have had a CT scan when he initially was seen for headaches. The plaintiff’s attorney in the deposition indicated that I, having access to all his medical records when I saw him for his back strain, should have seen that a year previously he was seen for headaches, reopened the issue and ordered a CT scan.
    My partner decided to quit clinical medicine over this, took a fellowship in epidemiology, and eventually got a job in another state dealing with funding for AIDS research. The suit dragged on for years. Twice a trial date was set, my former partner took time off to fly back for the trial, and the trial was continued at the last minute. Finally, never planning on practicing clinical medicine again, he suggested we settle out of court. I was totally opposed to this and stated there would be no settlement while I was on the case. I felt like neither he nor I, nor another partner peripherally sucked into this, had done anything wrong, and felt that we had a good case. Having said that, I have no idea what a jury would have decided – like I said, I think the outcome would have been a crapshoot. At that point I was dropped from the case and the settlement was made. I’m still pissed about the whole thing. And it doesn’t take much to get me to order ct scans for headaches.

    Matt would be in favor of any reform of the system to get more money to the injured party, as long as it doesn’t cut into the legal fees.

    We live in an era where carousel horses have to have seatbelts for liability reasons. This generates considerable amusement in my neck of the woods where a popular entertainment is getting on the back of an angry bull. The state actually has a law that a real horse is an unpredicatable animal, and if you are on a trail ride and get thrown off you can’t sue. This law probably violates constitutional rights to sue, come to think of it.

    • Matt says:

      “We live in an era where carousel horses have to have seatbelts for liability reasons”

      I hardly find the fact that legislators pass laws to be representative of a threat. Legislators have passed laws banning lots of things simply because some donor asked.

      “Matt would be in favor of any reform of the system to get more money to the injured party, as long as it doesn’t cut into the legal fees.”

      Actually, I’m in favor of minimum government intervention in any arena, including yours. I don’t care how much the injured party gets, but I want them to have the opportunity to put on their case to a jury or judge without the government arbitrarily deciding its value. It’s the libertarian in me.

      As to what the attorneys get paid, that should be negotiated between the attorney and its client. I have no problem with parties to a contract negotiating that contract – do you?

    • DensityDuck says:

      “The state actually has a law that a real horse is an unpredicatable animal, and if you are on a trail ride and get thrown off you can’t sue. ”

      Oh, pish. A good lawyer could dispute the meanings of anything in that sentence, including “unpredictable”, “animal”, “trail”, “ride”, “thrown”, and “off”.

  16. brett says:

    “Now, if you want to define malpractice more clearly for each situation, there is nothing stopping physicians from doing that. After all, YOU set the standard of care. That’s on you to do. So do it. There is literally nothing whatsoever keeping you from putting out those guidelines. Except yourselves.”

    Matt:

    This is only one of the lies you keep repeating. Physicians can and do formulate guidelines and protocols.

    However, the STANDARD OF CARE is defined on a case by case basis by a jury of twelve people on that particular day.

    Following a “standard of care” does not prevent lawsuits.

    Also, what WC said is true. There is usually no opportunity for a prelawsuit depo because the first notification of a problem is notification of the lawsuit itself.

    Matt, do you really not understand how the medical-legal system works, or you do understand but just prefer to be an inflammatory troll?

    • Matt says:

      “Following a “standard of care” does not prevent lawsuits.”

      How do you know? When have you, or someone you know, carefully reviewed the evidence in a lawsuit you heard about, then applied it to your own similar situation, and still been successfully sued?

      And let’s be clear, the question shouldn’t be “been sued”, the question should be “successfully sued”. Receiving service of a lawsuit is merely the notice that someone has a dispute with you, and that you two cannot resolve it without possibly using the judge or jury. It also lets you know that you’re going to be asked to answer questions about the dispute, and you will have the opportunity to do the same as them. It may be that after that process you can reach agreement, or maybe not. It may be that at that time its determined your actions DID meet the standard of care, and you’ll be dismissed.

      But again, ANY country is going to have a process for doing just what I described. Letting people or entities with a dispute gather facts about the dispute. What you want to get rid of – the mere right of people to question you – is not an option.

      “Matt, do you really not understand how the medical-legal system works, or you do understand but just prefer to be an inflammatory troll”

      There is no “medical-legal system”. There’s a civil justice system, and medical malpractice is a cause of action within that system. The major distinction is that unlike many other negligence claims, you are for the most part REQUIRED to have an expert. That’s it. Other than that, the civil justice system functions the same for car wrecks, contract disputes (not all of those get a jury, of course), fraud claims, etc. Same process that you hate.

      I’m sorry you felt the need to call me a “troll”, but I’m going to chalk it up to the fact that you didn’t understand what you’re talking about. Hope the above helped!

      • brett says:

        Yes, I have been sued for following standard of care treatment. No, it was not “successful” by your definition. Judgement was found in my favor 12-0. Plaintiff got nothing. I got 4 years of emotional distress. The trial was 2 months. I lost 2 months of income. Legal costs were about 250K. We own our own mutual so that is direct costs. There were three other codefendants so lawyers probably earned 1 million, plaintif got nothing, I lost salary and time and sanity, the medical group lost 250K. (Yes, reporting expert witness to ethics boards)

        With a straight face, nothing wrong there and system functioning with efficiency and common sense?

        Same thing for another two week trial.

        And you still have not answered the second point — there is usually no opportunity for discussion because the first notice of a lawsuit is the lawsuit itself.

        I think you have said you have done 2-3 medmal cases with settlement pretrial because there was clear liability. no, I am not a lawyer but I have far more real world experience with the medical-legal —- Oh excuse me, I mean “civil justice” system than you.

        So yes, you are mostly inflammatory troll

      • Matt says:

        “No, it was not “successful” by your definition. ”

        I would venture to say it was not “successful” by any definition.

        “I got 4 years of emotional distress.”

        Well, considering that you physicians generally believe a LIFETIME of lost quality of life is only worth $250,000, no matter how much pain is involved, I don’t put a lot of value on you having to give a deposition and sit at trial. Wouldn’t you agree?

        ” We own our own mutual so that is direct costs.”

        You paid $250,000 out of your own pocket? No, so that’s not a “direct cost” to you. You claim it was a million you paid your defense lawyers? You sure about that?

        “With a straight face, nothing wrong there and system functioning with efficiency and common sense?”

        I don’t know the trial schedule, but if you had 8 weeks straight of trial, 40 days, then it sounds like a pretty complex case. It also sounds like the jury figured it out how you believe it should have gone, and resolved the dispute. How would you propose it be different given what was apparently a LOT of evidence? ANY system you devise to handle complex cases with lots of evidence is going to take quite a bit of time.

        “And you still have not answered the second point — there is usually no opportunity for discussion because the first notice of a lawsuit is the lawsuit itself.”

        You are correct on that. I am unaware of any insurer who will allow their insured to go on the record prior to the insurance lawyer being in the case, so you’re right, unless you made it known that you would give such a deposition, you generally won’t. You could, of course, let the parties know when the medical records request came in.

        Do you really think your insurer would let you give a pre-suit deposition?

        ” I am not a lawyer but I have far more real world experience with the medical-legal —- Oh excuse me, I mean “civil justice” system than you.”

        Really? Are you serious? Your ego has gotten in the way of your good sense. A “medical-legal” trial is virtually the same procedure as any other trial involving experts. So, with that in mind, how many Complaints have you drafted? How much discovery? How many depositions have you taken? How much evidence have you put on? How many motions for summary judgment have you drafted or responses to those?

        If the answer is what I think it is, none, then you may want to rethink your lofty ideas about your legal “experience”.

        “So yes, you are mostly inflammatory troll”

        Sounds like you think you’re smarter than just about any, so I can see why you’d think that.

      • brett says:

        matty,

        I won’t address all of your points because who has time and you don’t understnad a little sarcasm too well.

        Read carefully. We paid our lawyers over 250K. There were 3 other co-defendants so if they had to pay roughly the same then lawyers got about 1 million total. (250×4=1 million)

        On the topic of direct costs:
        -Loss of salary for trial and depo is a direct cost
        -we have a 5k “deductible” upfront cost for each suit we have
        -I pay roughly 15$ per patient I see (whether they pay or not) into our mutual insurance pool. I have worked roughly 10 years seeing about 4000pt/year = 600K. Maybe you don’t consider that a direct cost, or tax, or cost of doing business. I would like to have 10% of that. I could use 60K, couldn’t you?

        Regarding your final point. It is obvious I am not a lawyer. Sorry you can’t take a little jest and sarcasm. Still sounds like I have spent more time in a court room regarding med-mal than you. It’s Ok I don’t think less of you

      • Matt says:

        ” It’s Ok I don’t think less of you”

        Never wondered if you did. You’re an anonymous person on the internet.

        “I pay roughly 15$ per patient I see (whether they pay or not) into our mutual insurance pool. I have worked roughly 10 years seeing about 4000pt/year = 600K. Maybe you don’t consider that a direct cost, or tax, or cost of doing business. I would like to have 10% of that. I could use 60K, couldn’t you?”

        I could use all of the insurance money I pay. But I recognize that insurance has a value. Your argument doesn’t make much sense unless you don’t think insurance has a value. Do you think you’ve paid too much for what you’ve received? Have you received no money back from your mutual?

        I’m sorry you lost time in having to be part of the defense. In any system to resolve disputes, you may have to contribute some of your time. One day you may be a plaintiff in a case, and I’m sure the defense will be annoyed as well. They might even have some lost income. That’s simply the nature of resolving human disputes.

        I’d really like to see those hourly bills if you paid 4 lawyers $1Million in one standard med mal case. You sure that doesn’t include experts and other expenses?

  17. Matt says:

    The really funny thing about all of this is that yesterday Obama announced yet another restart of the healthcare bill. This will fundamentally affect your life on a daily basis in a way that being named in one lawsuit in 30 years that you were dropped from will never do.

    It will affect your income, your overhead, your quality of life, literally on a daily basis. But the combined effective political response from physicians consists of a few tepid endorsements from your largest lobbyist, the AMA?

    Yet propose some malpractice caps and declare a “crisis” and you’re marching on state capitols. Really? Do you guys have ANY sense of what’s happening in Washington? Or are you so far removed from the straight doctor-patient (no third party payor) roots of your profession that you feel overwhelmed by it?

    That’s a serious question.

  18. Matt says:

    I forgot – you can find the initial remaking of your lives here:

    http://www.whitehouse.gov/health-care-meeting/proposal

  19. Dave says:

    As I said, Matt, I’m don’t care that much about caps. Please stop harping on that, you sound like a broken record. And I doubt that anything coming out of Washington will affect my life as a practicing physician more than it already has in the past 35 years.

    I personally am in favor of a single payer system with universal coverage. I’m not however one of the doctors who were arrested at Baucus’s meeting to try to ensure that a public option was on the table. I may be in the minority on this particular item but most doctors I know are hoping for something that’s better than what we’ve got. I have spent a lot of time trying to render care to people who were poor or without insurance. When I first started in private practice we often saw patients at reduced rates or for whatever their insurance would cover, if we knew they were in financial straits, until the government lawyers decided that this was fraud and made it illegal. You’ll be in court if you do that now. Part of the reason I did this was that a pediatrician did it for my dad when he was a struggling student with 2 children and it made a big impression on him. Part of the reason I quit private practice to join a large health care system was to avoid the hassles I had with insurance companies about just simple things, like ordering home oxygen for people. As far as being removed from our doctor-patient roots, that’s just meant to be insulting, like a lot of your comments. We still deal with individual patients.
    I’m coming to the end of my career as a doctor and will soon enter it as a patient. I’m just hoping that when I need a primary care doctor there will be one around. Currently only 2% of the graduating medical school class is going into primary care compared to 50% when I did my training. 1/3 of primary care doctors are planning on retiring in the next 5 years. If that doesn’t worry you, it should. You too, Matt, will someday be a patient – later if you’re lucky, sooner if you’re not. Given your curent mindset, though, I would recommend a naturopath if you ever get sick.

    • Matt says:

      Dave, I reference caps, as I said earlier, because that is the centerpiece of every malpractice “reform” effort. I “harp” on them because that is what’s at stake.

      Now, you and I can have a discussion on alternatives, but when you vote for malpractice “reform” today you’re backing caps. Period. So you can see why I focus on it.

      As to single payer, I think it renders the legal discussion moot. As an employer, I’m interested to see the costs before deciding on it. As a patient, I’m not opposed to it, again though I don’t know that I’ve seen the costs.

      I’d be interested to hear the position of you and other practitioners. Most seem to oppose.

      ” As far as being removed from our doctor-patient roots, that’s just meant to be insulting, like a lot of your comments. We still deal with individual patients.”

      Not at all meant to be insulting. I think your payment system naturally removes you from your patients. And them from you. Unlike any other profession. They don’t put as much value in your opinion and your services because they don’t know how to value them. And you don’t approach them the same way you would if you were collecting directly from them. Do you disagree?

      “until the government lawyers decided that this was fraud and made it illegal”

      Government LAWYERS may have pursued the claim, but it was a law that was passed that caused it. What you need to ask yourself was who benefited from such a restriction, and then you’ll know who backed that law and who to blame. That’s how modern government works.

      ” You too, Matt, will someday be a patient – later if you’re lucky, sooner if you’re not. Given your curent mindset, though, I would recommend a naturopath if you ever get sick.”

      You mistake my position for dislike. I do not dislike physicians. I dislike most of their politics when it comes to injured patients, but as a professional myself, I respect them immensely. I can disagree strongly with most physicians’ goals of trying to restrict the rights of the injured without disliking you in total.

  20. Dave says:

    I do apologize for the last comment. I dont mean to fall to that level.

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