If farmers and cowboys can be friends, why can’t doctors and attorneys? If both sides would take a step back, they might realize they have a lot in common. It would be refreshing if we declare posturing out for 2010 and working to find common solutions in as we start a new decade.
For example, Plaintiff’s attorneys are interested in finding more economical and efficient means of resolving medical malpractice claims. Sound familiar? It’s one of the leading arguments advanced by doctors for “tort reform”. Why don’t both sides stop huffing and puffing about the value or evils of tort reform and spend time together trying to identify ways that both sides can support that will help reduce the costs and time involved in resolving medical malpractice claims.
Doctors hate the fact that all settlements of medical malpractice claims must be reported to a federal agency and become part of a national data bank. It may surprise the medical profession but many plaintiff’s attorneys feel the same way, including me. I will discuss why this reporting requirement should be abolished in a later blog. For now, it serves as an example of where the interests of doctors and plaintiff’s attorneys overlap and where a combined effort to achieve a common goal could make a difference.
Are doctors prematurely leaving their practices because of the high cost of medical malpractice insurance? Many doctors claim this is so. Plaintiff’s attorneys do not agree or are at least not sure. But, if it is so, it is not something that plaintiff’s attorneys either seek or desire. Plaintiff’s attorneys have the same medical problems as everyone else and need doctors to deliver our babies, to see our loved ones in the emergency room, and to monitor our health through annual physical exams.
Instead of arguing, why can’t doctors and attorneys join forces to insist that a thorough and objective investigation be undertaken to definitively determine the reason for the exorbitant costs of medical malpractice insurance? Is it due to price gouging by a very unregulated industry? Is it the result of poor management and investment decisions within the insurance industry? Or is it a reflection of the cost of defending and resolving malpractice claims as the nsurance industry claims?
Having found the answer to that question, doctors and attorneys can then work together to solve the underlying problem, whatever it may be, and bring doctors'insurance premiums down to reasonable levels.
Doctors and attorneys can be friends. If they would, they could accomplish a great deal in the next decade, unlike the decade past.
Happy New Year.
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There may be some hope. I am a physician and posted a piece authored by a plaintiff's attorney who sues physicians. There is reasonableness out there, but its hidden and hard to find. www.MDWhistleblower.blogspot.com
ReplyDeleteDaniel, thank you for your excellent thoughts and questions on my blog:
ReplyDeletehttp://tryhardclimbers.blogspot.com/2009/12/health-care-reform.html.
I am impressed that you found it. I agree with you that I have not spent enough time truly considering this topic in-depth. The complexity of the situation and my relative naivete about anything non-medical (save climbing and guitar) render me as useless as most physicians trying to engage in business or politics. We are at a huge disadvantage since all of our training is towards the single goal of providing the best care possible to all patients.
The truth is when I practice medicine, I think only about the patient's well being. It is only when I go home after a shift that I think "did I really need that test?" or worse "should I have gotten another test?"
I think you are right, CT scans that I order unnecessarily will cause some leukemias down the road. that is horrible, and I try to use all my skills to choose the right times to pull the trigger. In the end it's often a "gut instinct" or a guessing game. There is such a huge grey area.
One huge problem is that hindsight is 20/20 but when faced with the immediacy of a decision, one holds no crystal ball. There is often only a right and wrong after the outcome is known, and that is the minefield which is modern medicine.
You also asked:
"Your statement that you are doing things that aren't necessary to avoid losing your license. Do you know or have you even heard about any physician who has lost his license for ordering tests that were unnecessary. Or for not ordering a test that was even prospectively deemed unnecessary much less considered unnecessary retrospectively?" -- The answer is of course, no. However, it's not the ordering or not ordering that is the problem, it is the outcome of the case with relation to the decision to order. For example, not getting a CT scan in a kid with a grey area history for appendicitis can get you sued/lose your license (worst case scenarios, of course) but ordering it for a kid who doesn't have appendicitis could give the kid leukemia, etc. 10-20 years down the road... It's a nightmare of a minefield. It's complex, high-risk decision making with not enough information. It is VERY difficult. I see 1000's of cases like this a year, there are bound to be mistakes, no matter how amazing or perfect the physician is. It's just plain odds. One "screw-up" can mean lawsuit which can mean unisurable physician which can mean no job which can mean big problems. This HAPPENS to us. It's disgusting.
I agree that the insurance industry is a huge problem for us, probably the primary problem, and I agree that physicians do not spend enough time battling for ourselves, mostly because we're too busy studying and reading try to stay current with modern medicine and its frequent changes in "standard of care."
Daniel, you must concede, however that there is great profiteering going on by many in the judicial system (eg Sokolove,) as there probably is to some degree in medicine itself. Frivilous lawsuits against physicians are real and they are a real problem, hiking up our med mal insurance and eroding our income.
Helping people is priceless and is the only reason left for choosing a career in medicine. That is why I will continue to watch my income plummet. I always wanted to be a doctor. It's a disaster watching your income drop EVERY YEAR and being mostly powerless to do anything about it. Especially when you owe $200k for med school and don't start earning income until you are 30+ years old.
Thanks for your comments, Daniel. Is there anyway you can help us? I want to be friends.
Noah Kaufman, MD
Emergency Medicine
boulderdoc@gmail.com
(330) 701-4614
Similarly, in cases of medical errors, misdiagnoses, faulty prescriptions, or surveillance, it is advisable to consult a lawyer with a proven winner mitigate such negligence. Alternatively, you can consult a malpractice lawyer for legal advice. It can refer to another lawyer believed to have a rich experience in handling cases similar to yours.
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