tag:blogger.com,1999:blog-7323692122514281455.post7631353246263434663..comments2024-03-22T17:05:55.267-04:00Comments on MD Whistleblower: Unneccesary Medical Tests: Tort Reform Can't Solve it AllMichael Kirsch, M.D.http://www.blogger.com/profile/07555280388086931097noreply@blogger.comBlogger33125tag:blogger.com,1999:blog-7323692122514281455.post-73006016266615344092011-09-26T11:49:05.456-04:002011-09-26T11:49:05.456-04:00highly technical. glad that there are physicians c...highly technical. glad that there are physicians commented on this page they should have helped you. <br /><br /><a href="http://techniciansalary.net/technician-interviews/" rel="nofollow">technician interviews</a>Merr Haphttps://www.blogger.com/profile/11638184365068031957noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-29704068595655265562010-07-22T09:24:25.227-04:002010-07-22T09:24:25.227-04:00I commend your courage and your ability to "r...I commend your courage and your ability to "risk the outrage". You are obviously trying to do the right thing, in a sincere manner, and this may well inspire others to have the courage to be whistleblowers, even if they are not necessarily in your profession. Keep it up!<br />Eric Tippmann<br />CardiffEric Tippmann, PhDnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-87683861109004674992010-06-22T21:07:10.135-04:002010-06-22T21:07:10.135-04:00Your solutions for the liability system haven'...Your solutions for the liability system haven't changed the overutilization problem. So either your solutions stink and we should quit trying them OR it's not a driver after all.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-12041255124059102312010-06-22T17:58:27.014-04:002010-06-22T17:58:27.014-04:00@anonymous, I completely agree that money is a for...@anonymous, I completely agree that money is a force that drives overutilization. The medical liabily system is another force that pushes care in the same direction. Any force or influence that generates unnecessary medical care should be targeted.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-88767771167742170492010-06-22T17:54:17.543-04:002010-06-22T17:54:17.543-04:00It's always interesting when "defensive&q...It's always interesting when "defensive" medicine is tossed about as proof of the need for tort reform. Not just because the "reform" has never been shown to reduce it, though. But because it's becoming more and more clear from actual studies rather than anecdotes that what drives testing is money, not liability concerns. <br /><br />Take for example:<br /><br />http://content.healthaffairs.org/cgi/content/full/hlthaff.2009.0563v1<br /><br />"The Medicare Prescription Drug, Improvement, and Modernization Act, enacted in 2003, substantially reduced payment rates for chemotherapy drugs administered on an outpatient basis starting in January 2005. We assessed how these reductions affected the likelihood and setting of chemotherapy treatment for Medicare beneficiaries with newly diagnosed lung cancer, as well as the types of agents they received. Contrary to concerns about access, we found that the changes actually increased the likelihood that lung cancer patients received chemotherapy. The type of chemotherapy agents administered also changed. Physicians switched from dispensing the drugs that experienced the largest cuts in profitability, carboplatin and paclitaxel, to other high-margin drugs, like docetaxel. We do not know what the effect was on cancer patients, but these changes may have offset some of the savings projected from passage of the legislation."Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-83870692704056625432010-06-20T18:36:46.274-04:002010-06-20T18:36:46.274-04:00Nick, thanks for dropping by. I'm sure that r...Nick, thanks for dropping by. I'm sure that radiologists regularly talk amongst themselves about silly tests that the rest of us order. Regarding your cardiac echo anecdote, the cardiologist may be pushing back against a deluge of inappropriate use, which does not apply to you.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-11459423181359445712010-06-19T21:13:40.048-04:002010-06-19T21:13:40.048-04:00Mike - interesting post - very well written!
I se...Mike - interesting post - very well written!<br /><br />I see it both ways. Sometimes I have called for an echocardiogram and the cardiologist has gotten all uptight about why I wanted it. The truth is that unless the cardiologist is particularly trained in cardiac disease in pregnancy, its not that likely that I want his deep opinion on the topic - I'll get that from a maternal fetal medicine doctor. As such, when academic cardiologists consider themselves the guardians of the echo machine it drives me a bit nuts.<br /><br />On the other hand, your points on radiologists are spot on. Talking to radiologists ahead of scans is very helpful. This is not only for determining what study to order, but also to help with the interpretation. I review the images on every study I order, in most cases face to face with the radiologist. I find I get much better reads that way, and in some cases have given the radiologist information that led them to a interpretation they would have missed without that information.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-66913813170223257052010-06-16T17:38:17.995-04:002010-06-16T17:38:17.995-04:00"When a physician discusses diagnostic testin..."When a physician discusses diagnostic testing options for defensive medical purposes"<br /><br />So it's a bad thing the consumer has more choice? You guys talk about defensive medicine ad nauseum, but the thing is 1) you don't know if it actually defends you, and 2) you say we need to enact your caps so it will lessen but it never has worked. Can you tell me why in the world we're still talking about it?<br /><br />" We are seeking to avoid becoming defendants when we shouldn't be."<br /><br />So how do your caps help that? Other than indiscriminately limiting the value of all cases regardless of merit?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-67726820707783971642010-06-16T16:34:37.687-04:002010-06-16T16:34:37.687-04:00"In addition, the med mal system directly aff..."In addition, the med mal system directly affects doctor-patient communication.<br /><br />How so?"<br /><br />When a physician discusses diagnostic testing options for defensive medical purposes, this directly affects communication and the doctor-pt relationship.<br /><br />"So why are they[physicians] always trying to "reform" [med mal system] it to favor their liability carriers if they have such a limited understanding?"<br /><br />We are not motivated to help insurance companies. We are seeking to avoid becoming defendants when we shouldn't be.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-73830122833882633272010-06-16T16:24:49.679-04:002010-06-16T16:24:49.679-04:00" I maintain that the goals are reasonable an..." I maintain that the goals are reasonable and relevant. "<br /><br />They are - for medicine. <br /><br />"While I don't agree with this argument, it is out there. "<br /><br />I agree there are those who would advance it. And it might have merit in those rare, rare cases where a physician would be inclined to act while drunk, for example. But at that point, judgment isn't really one's strong suit.<br /><br />"In addition, the med mal system directly affects doctor-patient communication."<br /><br />How so?<br /><br />"I also suggest that physicians have more than a limited understanding of the legal system."<br /><br />So why are they always trying to "reform" it to favor their liability carriers if they have such a limited understanding?Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-67932054425145064622010-06-16T12:16:39.608-04:002010-06-16T12:16:39.608-04:00The four goals of tort reform that we both referen...The four goals of tort reform that we both referenced in our above comments are not my goals, but are from a recent New England Journal of Medicine article (reference appears in an above comment.) I maintain that the goals are reasonable and relevant. You state that the tort system is only designed to compensate injured patients. I have heard plaintiff lawyers repeatedly argue that the current liability system serves as a deterrent against marginal medical care,, in addition to compensating victims. While I don't agree with this argument, it is out there. In addition, the med mal system directly affects doctor-patient communication, so this 'goal' is quite relevant to the issue also. I also suggest that physicians have more than a limited understanding of the legal system.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-75935239065638928732010-06-16T12:02:39.252-04:002010-06-16T12:02:39.252-04:00""To improve both patient safety and the...""To improve both patient safety and the medical liability climate, the tort system must achieve four goals: reduce the rates of preventable patient injuries, promote open communication between physicians and patients, ensure patients access to fair compensation for legitimate medical injuries, and reduce liability insurance premiums for health care providers.""<br /><br />In other words, you are criticizing a process designed to determine liability and damages for not doing a bunch of things it was never designed to do. Other than give patients an opportunity to get compensated. <br /><br />One could just as easily criticize the delivery of medical services by physicians for failing to accomplish those same things. Oddly though, physicians don't want to reform themselves, but the legal system. Even though they have a limited understanding of it.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-27416971769717887502010-06-16T12:00:10.636-04:002010-06-16T12:00:10.636-04:00"I don't think that the current medical l..."I don't think that the current medical liability system succeeds on any of these measures"<br /><br />Nor do any of the "reforms" proposed by you, and backed by your liability carriers, change that. Which makes your crocodile tears for "meaningful reform" obvious.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-72899212900318106172010-06-13T18:41:48.704-04:002010-06-13T18:41:48.704-04:00I absolutely agree that medical errors be disclose...I absolutely agree that medical errors be disclosed promptly, independent of the legal ramifications of this action. Disclosure is an ethical obligation the medical profession. That this might lessen a patient and family's desire to sue, is an indication of the rapport between the physician and the patient. This likely depends upon the seriousness and long term consequences of the error. Mistakes that go away are easy to forgive and forget.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-87506708898101939572010-06-13T17:03:35.599-04:002010-06-13T17:03:35.599-04:00Agreed.
My reading of the link indicates those re...Agreed. <br />My reading of the link indicates those results are the stated aim of the proposal.<br /><br /><i>Under our proposal, physicians would be given certain <b>protections from liability</b></i><br /><br />And later...<i>A number of hospital systems and liability insurance providers <b>have already</b> adopted a policy of robust disclosure of medical errors. These programs have been successful in reducing administrative and legal costs for providers, insurers, and hospitals. Surveys also show greater trust in and satisfaction with health care providers on the part of patients. Ultimately, through these programs, disclosure of medical errors has resulted in the filing of <b>fewer malpractice suits, a reduction in litigation costs, accelerated provision of compensation to patients, and increases in the numbers of patients who are compensated for their injuries.</b></i><br /> <br />The intent is to quantify and standardize practices already shown to work. Providers following best practices enshrined in legally protective language are protected. And those that fail to do so remain properly liable. <br />What am I missing?Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-80978584717734218212010-06-13T14:53:44.078-04:002010-06-13T14:53:44.078-04:00John, here is an excerpt from the New England Jour...John, here is an excerpt from the New England Journal link you kindly provided:<br /><br />"To improve both patient safety and the medical liability climate, the tort system must achieve four goals: reduce the rates of preventable patient injuries, promote open communication between physicians and patients, ensure patients access to fair compensation for legitimate medical injuries, and reduce liability insurance premiums for health care providers."<br /><br />I don't think that the current medical liability system succeeds on any of these measures.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-42032649544889212462010-06-13T14:05:41.649-04:002010-06-13T14:05:41.649-04:00The Office of Patient Safety and Health Care Quali...<i>The Office of Patient Safety and Health Care Quality would conduct three studies:<br /><br />1.)an analysis of the patient-safety data from its new database and other sources to determine performance and systems standards, as well as safety tools and best practices for health care providers;<br /> <br />2.)<b>an analysis of the medical liability insurance market to determine historical and current legal costs related to medical liability, factors leading to increased legal costs, and which, if any, state liability insurance reforms have led to stabilization or reduction in medical liability premiums</b>; and <br /><br />3.)a database study of cases that were not successfully negotiated through the new program, to determine the reasons, trends, and effects of such outcomes.</i><br /><br /><a href="http://content.nejm.org/cgi/content/full/354/21/2205" rel="nofollow">Found at this New England Journal of Medicine link.</a><br /><br />I presume you consider all this a waste of time and resources.Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-16978107147530901942010-06-13T11:35:49.561-04:002010-06-13T11:35:49.561-04:00Thanks for the link, John. The Obama folks want t...Thanks for the link, John. The Obama folks want to 'study' tort reform. We all know what that means.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-43102828021842268612010-06-12T19:57:16.076-04:002010-06-12T19:57:16.076-04:00Dr. Kirsch, here's a link for you.
http://bit...Dr. Kirsch, here's a link for you.<br /><br />http://bit.ly/aKNPub<br /><br /><i>After evaluating the success of existing efforts and consulting with a seven-member panel of diverse stakeholders, the initiative announced the availability of $20 million in development grants and planning grants “to states and health care system” and yesterday, on a conference call with reporters, the group unveiled some of the applications they received and the projects that would be funded. </i><br /><br />More at the link.Johnhttps://www.blogger.com/profile/11858939352263715787noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-63678035460114273312010-06-09T14:08:43.138-04:002010-06-09T14:08:43.138-04:00Hello Dr. Kirsch,
I'm Kate Wharmby Seldman, ...Hello Dr. Kirsch, <br /><br />I'm Kate Wharmby Seldman, the Health and Entertainment Editor at Opposing Views (www.opposingviews.com). Sorry to spam your comments, but I couldn't find a contact email anywhere on your site.<br /><br />We're a growing online news/information platform that publishes expert opinions, analysis, questions and answers from groups such as PETA, the NRDC, the NRA and Amnesty International. Each month hundreds of thousands of readers (and viewers, we also offer video) come to Opposing Views to learn about and discuss important issues.<br /><br />In an effort to build a signficant autism section, we're reaching out to experts on the subject, and I thought you would make a strong addition. If you're interested and have the time, we'd like you to become an Opposing Views expert.<br /><br />What does being an expert mean? Essentially, you give us permission to publish content from your site through an RSS feed or by posting it directly on our site. Your content will reach an even wider audience and we include a byline and links to your site which enhance your position on Google and other search engines. In addition, the majority of our content is carried on Google news, Facebook, Twitter and other news and media sites.<br /><br />Please contact me with any comments and/or questions, and let me know if you'd like to join us.<br /><br />Kate Wharmby Seldman<br />Health and Entertainment Editor<br />healtheditor@opposingviews.com<br />Opposing Views<br />www.opposingviews.com<br />Los Angeles, CA<br />310-488-6847Kate Seldmanhttp://opposingviews.comnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-82050798910056927442010-06-08T14:03:48.906-04:002010-06-08T14:03:48.906-04:00No, those stats are right on. There's no doub...No, those stats are right on. There's no doubt the number of claims and payouts have gone down. Even putting aside the fact that obviously the claims will go up significantly immediately before the law goes in effect. However, I don't know that it's evidence that the law is good for injured parties or the public in general. It is evident that it's more difficult to pursue a case in Ohio or get the full measure of damages, regardless of the merit of the case. That's certainly good for insurers, which is after all the point.<br /><br />Your claimed benefit to the public doesn't seem all that evident. Healthcare is no cheaper, defensive medicine is no less prevalent, and Ohio doesn't seem to have a big jump in physicians. Which is consistent with most "reform" efforts by physicians and their insurers. In fact, if one looks at the rankings by state of physicians per capita, one will see the one driver of that is the wealth of the state. Rural, poor states have fewer physicians per capita than wealthier urban ones, regardless of caps. <br /><br />You don't need to prepare a dissertation. The facts are clear, and undisputed. You can verify the physicians per capita from multiple unbiased sources, and likewise with the state income. You'll see the same trend if you dig down to the county/parish level as well.<br /><br />As to your question, only the insurer will have that. They will release some information, but now raw. Although, if a small fraction do pay post suit, and you believe most claims are without merit, that would seem to be evidence that the process to weed out meritorious claims is working quite well.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-21309179585256317012010-06-08T12:44:00.183-04:002010-06-08T12:44:00.183-04:00Here is a link regarding some statistics on Ohio&#...Here is a link regarding some statistics on Ohio's medical malpractice history. http://bit.ly/9233BL This is from an Ohio physician medical society, so you can feel free to challenge its credibility. I cannot prepare a dissertation on this issue, as I am trying to earn a living today. I would be interested if you know, or can find out, what fraction of physicians who are sued end up paying a settlement or having a court judgement against them. I assume it is a very small percentage, but would appreciate 'hard data', if you can provide it. I thank you for contributing to this blog.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-56435975199875737802010-06-08T10:26:32.642-04:002010-06-08T10:26:32.642-04:00". Nevertheless, tort reform here has lowered...". Nevertheless, tort reform here has lowered our premiums, stopped the hemorrhaging of medical talent leaving the state and reduced the volume of medical malpractice cases, most of which never result in a victory for the plaintiff."<br /><br />Dr. Kirsch, can you point us to where we can find support for any of these claims. For example, rates have fallen (and risen) in both capped and noncapped states pretty much in lockstep with the economy. So can you show us where Ohio rates have declined more than in a similar state without caps?<br /><br />Can you also tell us how reducing the volume of medical malpractice cases has anything to do with merit of the case? Or improvements in medical quality? Or is a boon to anyone besides insurers? BTW, Ohio at its peak had around 600 paid claims in 2003. Out of nearly 40,000 physicians. <br /><br />Also, you claim it has stopped the bleeding of Ohio physicians? In 2008, Ohio had 38,556 nonfederal physicians. The number in 2003, at the height of the "crisis"? Just shy of 34,000. Rate of increase has been steady over the last decade, both pre and post-"reform". In fact, it's even declined a bit since "reform". <br /><br />But of course, you've still not explained how caps achieve any of your stated goals. However, it's quite clear you support the insurers' goals.Anonymousnoreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-53774463489899109382010-06-07T22:50:13.581-04:002010-06-07T22:50:13.581-04:00I wonder if one factor involved in the radiologist...I wonder if one factor involved in the radiologist failing to say "no" or "not indicated" to common radiologic procedures is the inability to have a full history or physical exam or time to read full reports or communicate directly with the patient. Nevertheless, certainly a "cognitive consultation" in some form between the radiologist to the requesting physician would be most appropriate act. ..Maurice.Maurice Bernstein, M.D.https://www.blogger.com/profile/07618638650784869923noreply@blogger.comtag:blogger.com,1999:blog-7323692122514281455.post-9265685416026781162010-06-07T21:00:36.052-04:002010-06-07T21:00:36.052-04:00@LG, while there is corruption in the profession, ...@LG, while there is corruption in the profession, this is not germane to the case in this post. I am addressing medical competence and ethics, not corruption.<br /><br />@anonymous, tort reform in Ohio has helped enormously, even though that I have commented repeatedly that I do not feel that 'caps' are ideal. Nevertheless, tort reform here has lowered our premiums, stopped the hemorrhaging of medical talent leaving the state and reduced the volume of medical malpractice cases, most of which never result in a victory for the plaintiff.<br /><br />@ES, analogy noted, but I doubt you are under the same pressure as GI physicians. Primary care folks, I think, expect more cognitive input from hematologists than they do from us.<br /><br />@Anar, thanks for the comment. Keep in mind that under the present system that radiologists have a financial conflict of interest that may influence their recommendations. My specialty faces similar conflicts.Michael Kirsch, M.D.https://www.blogger.com/profile/07555280388086931097noreply@blogger.com