Over the past week or so, I have been engaged in a colloquy with a presumed lawyer on tort reform on KevinMD’s blog. It has been a frustrating and unsatisfying exchange. I have had many discussions with attorneys over the years, and I am always struck by the gulf that separates us on this issue. I regard myself as a fair-minded individual. I believe that I can separate my own self-interest from the public interest. Indeed, many Whistleblower postings take aim at my own profession and have generated some spirited responses from my colleagues, some of them delivered offline. Although I am a gastroenterologist, I will not defend the value of colonoscopy when a better option for patients emerges. I admit and write that our health care system is riddled with excesses and inefficiencies and that we physicians deviate from evidence based medicine regularly.
Lawyers, at least those who I’ve spoken with, express an unwavering fidelity to the tort system. This is why the dialogue between the professions is so strained. I don’t believe that they put the public’s interest ahead of their own. Would they defend the current system as vigorously as they do now if it didn’t enrich them personally? Using my colonoscopy example above, if we created a tort system that provided more fairness and justice to the parties involved, would lawyers support it if their incomes would suffer as a result?
When an organization or a profession claims that no reform is needed, despite an avalanche of evidence to the contrary, then the credibility of the institution erodes. Yet, lawyers defend even the most glaring defects in the tort system as essential elements that require no remedy. When physicians argue that innocent doctors are unfairly drawn into the legal vortex, lawyers respond that their innocence cannot be assumed and must be established. When innocent doctors complain that they remain attached to lawsuits for years before dismissal, they are told that the legal process is a methodical process. In this instance, they point to the physicians’ ultimate dismissal as evidence that the process is fair. When physicians state the the tort system fuels uneccessary and defensive medicine, they counter that they provide an important deterrence function over the medical profession. When we point out that the tort system misses most true medical negligence, they respond that this is evidence of lax physician oversight over its own practitioners. I could easily extend this paragraph with additional examples.
In my mind, this dispute is not a true controversy where two reasonable viewpoints are juxtaposed. One profession admits its own failings and asks the other for relief and understanding. The other, in contrast, claims it needs no reform and should be preserved, if not strengthened. How can you talk with someone who is always right? You can’t dialogue with an idealogue.
Lawyers, at least those who I’ve spoken with, express an unwavering fidelity to the tort system. This is why the dialogue between the professions is so strained. I don’t believe that they put the public’s interest ahead of their own. Would they defend the current system as vigorously as they do now if it didn’t enrich them personally? Using my colonoscopy example above, if we created a tort system that provided more fairness and justice to the parties involved, would lawyers support it if their incomes would suffer as a result?
When an organization or a profession claims that no reform is needed, despite an avalanche of evidence to the contrary, then the credibility of the institution erodes. Yet, lawyers defend even the most glaring defects in the tort system as essential elements that require no remedy. When physicians argue that innocent doctors are unfairly drawn into the legal vortex, lawyers respond that their innocence cannot be assumed and must be established. When innocent doctors complain that they remain attached to lawsuits for years before dismissal, they are told that the legal process is a methodical process. In this instance, they point to the physicians’ ultimate dismissal as evidence that the process is fair. When physicians state the the tort system fuels uneccessary and defensive medicine, they counter that they provide an important deterrence function over the medical profession. When we point out that the tort system misses most true medical negligence, they respond that this is evidence of lax physician oversight over its own practitioners. I could easily extend this paragraph with additional examples.
In my mind, this dispute is not a true controversy where two reasonable viewpoints are juxtaposed. One profession admits its own failings and asks the other for relief and understanding. The other, in contrast, claims it needs no reform and should be preserved, if not strengthened. How can you talk with someone who is always right? You can’t dialogue with an idealogue.
As I believe I am the lawyer in question, perhaps you'll permit me to respond.
ReplyDeleteFirst, we need to clear something up. There is no "tort system". It doesn't exist. There is a civil justice system that covers everything that does not involve criminal law.
I have no doubt you regard yourself as a fair minded individual, and believe you can see both sides of an issue. But that does not mean you do not have your own biases, and that you cannot be blind to them. One of the advantages (although it makes you a boring person) of legal training over medical training is that you are trained to see the other side's position. In fact, you must be able to do so to be an effective lawyer. So I can appreciate where your side is coming from. Being sued sucks, and in multiparty litigation, it takes time. But anything complex can and does take time, and do you really want this rushed?
Where we really diverge is in your remedies to what you perceive as a problem. Tort "reform" has been going on for the past 30 years, always in response to a "crisis" (which happen regularly) and all with the same "solutions". These solutions are generally caps on what people can recover regardless of whether there was malpractice. So we have had these "reforms" for decades, yet there is no evidence that they work. You cannot show that defensive medicine has been reduced in these reformed areas, for example, or that all the sudden specialists are flocking to the middle of nowhere now that we've had reform in these places, which are two common reasons we need "reform" that are put out by the proponents of tort reform. (Assuming we can agree on what defensive medicine is, since one physicians defensive MRI is another's necessary test).
Your other typical complaint is that the process is too long, and too costly, and that it's not actually rooting out malpractice. Probably true. However, your version of "reform" doesn't address those. There is no legislative proposal from physicians which pays more victims of malpractice faster. For the simple reason the insurers don't want that. The only proposals are ones that let lobbyists decide the value of cases they've never seen, to the benefit solely of liability carriers, and occasionally to physicians if the insurers feel like passing savings on. If, as you claim, one profession was admitting its own failings, wouldn't we see a proposal to pay for the harm caused by those failings quickly and efficiently?
No one in the legal profession is saying that the jury system is infallible. No system involving humans is. What is being said is that your "solutions" to the problems are not actually solutions at all, merely cost saving measures for insurers.
Now, I have no doubt you can tell me about this reform and that reform you believe in, but until I see it in a legislature getting brought up to a vote, that doesn't mean much. It's just empty talk. And that may be where the disconnect is. You are using the term "tort reform" to describe these wonderful innovations in your head, but the lawyers are seeing it for what it is on the ground, which isn't designed to help victims at all.
The other place we differ is that physicians' claims are very thinly sourced. All physicians believe, for example, that there are too many medical malpractice claims. But are there? How many are there? How many should there be given typical error rates? Have claims increased or decreased nationwide at a rate greater than the patient/physician encounters? No physician can tell you these things, yet it's an article of faith with them that there are too many malpractice lawsuits. And yet, you accuse the other side of being ideologues?
I would love to hear proposals to improve the system which benefited BOTH sides. Yet you have offered nothing substantively, and accuse the other side of being anti-reform? Hardly seems open minded on your part.
First Matt, I will no longer refer to you as a presumed lawyer, now that you have identified your occupation with certainty. I agree with many of your comments. It is true that most physicians, like myself, have not quantified with precise data the actual number of malpractice claims,settlements, etc. It is also true, however, that nearly every practicing physician is adversely influenced by the threat of a medical malpractice allegation or lawsuit. While this is not 'hard data' that can be entered on a spreadsheet, it is nonetheless real. Ask physicians you know and respect about this and I guarantee you they will explain how the tort system increases unnecessary medical testing, decreases their morale and strains the doctor-patient relationship. If our most competent physicians experience this, then I suggest that the current system isn't working properly. Examine radiologists' reports and you will see that nearly every one concludes with arecommendation for more testing. This is not for medical reasons, but for medicolegal reasons. This then forces the ordering phsyician do continue the cascade and creates anxiety in a healthy patient. Every medical specialty can offer similar anecdotes.
ReplyDeletePhilosophically, I have never embraced caps on patient financial recovery. I changed my mind, however, when I personally witnessed many colleagues in Northeast Ohio forced out of state because of unaffordable malpractice premiums. These were capable doctors, not rogue practitioners. I decided to support caps, even though a few deserving patients would not be fully compensated, in order to serve the greater good. Indeed, our premiums here have stablized once tort reform became law.
I think there are alternatives to be considered. Just because I can't design an ideal or a better system in a blog posting, doesn't mean that the current system should be maintained. We could compensate all patients who experience an adverse medical result regardless of whether malpractice occurred. We could require rigorous screening to assure that only cases that demonstrate a reasonable probability of malpractice could proceed. This would prevent lawsuits against multiple physicians and institutions being filed, such as the one I decribed in my prior posting. Obviously, the affidavit of merit required in Ohio by an 'expert' is a joke. The contingency fee system also should be examined. When patients have no financial risk, they may be more apt to proceed with litigation on dubious grounds. Similarly, in the medical arena, patients are quite willing to undergo MRI studies etc., when someone else is paying for them.
Since you state that your trained to understand the other side's point of view, how would you view the current system if you were a physician?
"It is also true, however, that nearly every practicing physician is adversely influenced by the threat of a medical malpractice allegation or lawsuit."
ReplyDeleteAren't we all though? Simply as people who drive down the road, enter into contractual relationships, etc. we are all subject to a dispute or our negligence resulting in a lawsuit.
For example, I have no doubt that physicians perform some unnecessary testing because of a fear of lawsuits. How much we would probably disagree on simply because physicians don't even agree on what is and is not "necessary" all the time. But my point is that physicians don't even know if this extra testing WORKS to reduce their exposure. Without hard numbers how can you? You're reacting to at best anecdotal evidence. Yet physicians want us to make wholesale policy changes based on what can only be characterized as thinly sourced positions.
You say your premiums in Ohio have "stabilized", but what does that mean? Are the insurer's payouts less year over year adjusting for medical inflation? Were their loss reserves accurate over the past couple of decades? Have they invested wisely over the past couple of decades? Insurance is a long term industry, yet physicians want to tell me how much this or that insurer lost over one or two years. Well, without knowing more about why they lost it, whether they run a tight ship, etc. how can you attribute any stabilization to caps being enacted? Did states without caps experience the same "stabilization"? If you don't know, how can you say what did or did not cause it? What we can say is that caps don't discriminate between frivolous and meritorious cases, and generally hurt the weakest members of our society (those without economic damages).
". The contingency fee system also should be examined. When patients have no financial risk, they may be more apt to proceed with litigation on dubious grounds."
But the lawyer does have that financial risk, doesn't he or she? The cost doesn't disappear, it's just shifted. You say we need to get rid of the current system, and that's fine, but you can't just eliminate it and not replace it with something.
How would I view the current system if I were a physician? That's almost impossible to answer, because it presumes I have then forgotten everything I know and had a medical education. But I think if nothing else, it would be wwwaaaayyyy down on my list of concerns. I would be so much more worried about single payer and what's happening in Congress now that it would rarely be an issue.
Were I to think about it, I think my first thought would be that I wasn't going to rely on just anecdotal evidence to reach a conclusion. I would want some hard numbers before I declare it "broken", a "lottery", etc.
I’m neither a doctor nor a lawyer but rather a former scientist and presently a software developer. I do not have a skin in a conflict between doctors and lawyers, but am reading this blog out of general interest to get educated on medical issues.
ReplyDeleteI’m rather sympathetic to the point of view expressed in the current post:
“One profession admits its own failings and asks the other for relief and understanding. The other, in contrast, claims it needs no reform and should be preserved, if not strengthened.”
I found the following post from Matt on KevinMD site that summarizes the defense of the current system and touts its superiority to all others:
“Is our system perfect? Of course not. No human system other than Halle Berry’s skin is perfect. But I have yet to see a system for adjudicating disputes any better.”
It seems that the lawyers making comments on this and other blogs have taken the following positions: 1) all proposals from doctors on medical tort reform are in their own interests or those of insurance companies and contrary to public interest, 2) doctors lack hard evidence to prove validity of their views, 3) there are vastly more significant issues on medical agenda that dwarf tort reform - consequently public attention should be focused elsewhere, and 4) the current system is as good as realistically possible AND it is very hard if not impossible to improve it.
Regarding 1), it’s not credible to claim that ALL doctors’ proposals lack any merit. A dialogue should be possible to find a subset that is in the interests of the public.
Regarding 2), opinions expressed in this and other doctor blogs regarding problems with the current tort system seem very reasonable and believable. I do regret a lack of firmer and more substantial evidence, but a lack of such evidence cannot be blamed on doctors any more than it can be blamed on lawyers. A lack of more substantial evidence does not invalidate blogger opinions.
Regading 3), bloggers are expressing their personal views and are not obligated to comment on the most significant issues to the public in decreasing order of importance. It has not been shown that tort problems are insignificant in their impact on medical cost and quality of care.
The last item, 4), is most troubling because lawyers commenting on blogs are defending the current system WITHOUT making any proposals for improvements. Matt is asking doctors for proposals that will improve and speed up compensation for victims at lower administrative cost. Fair enough. But should not the same expectations apply to lawyers? How can the latter claim that the current system cannot realistically be improved despite its numerous and egregious faults? No reasonable person can believe that. Can someone point out lawyer blogs discussing the flaws of the current system and possible ways to improve it? Have lawyers made proposals that will improve and speed up compensations for victims and reduce litigation? If so, what are they? Please educate us.
-- Alex J.
Alex J is correct IMO. I too am not a lawyer or physcian. The core of the problem relates to our political process. Many lay people believe it makes sense to have lawyers write the laws. That is the problem and that is contrary to the citizen-lawmakers our frames envisioned.
ReplyDeleteHaving lawyers write and interpret laws (as the vast plurality of lawmakers are indeed lawyers) is akin to have truck drivers write laws about trucking or farmers write laws about farming. We are allowing for a special interest group to write regulations and laws about their service.
In fact, this tends to always and naturally happen with those who are most affected by legislation -- but lawyers are special bcs virtually ALL legislation affects them.
As Alex points out, where are the examples of legal reform from the legal community? Matt, I suggest you put on a pair of jeans and a t-shirt and go visit 4 or 5 contingency lawyers about some made-up grievance you have (just to prove it to yourself). See what they tell you and how they refer you to unscrupulous experts - all to in effect extort a settlement from an insurance carrier. It is disgusting and if you are as ethical as you seem to indicate, you should be screaming for legal reforms. When that occurs, I'll take your comments more seriously.
"It seems that the lawyers making comments on this and other blogs have taken the following positions: 1) all proposals from doctors on medical tort reform are in their own interests or those of insurance companies and contrary to public interest"
ReplyDeleteIncorrect. A more accurate statement would be that the legislative proposals put forth are to advance the interests of insurers, and secondarily physicians and contrary to public interest. Doctors have lots of positive ideas, but they rarely if ever get much legislative traction, so lawyers don't really think of them as "tort reform".
2) doctors lack hard evidence to prove validity of their views"
Slightly incorrect. More accurately it is that physicians rely solely on anecdotal evidence. And lawyers do not believe that we should limit patients' rights based solely on anecdotes. I would think doctors, as scientists, would not be very comfortable relying solely on anecdotes to make major changes either.
3) there are vastly more significant issues on medical agenda that dwarf tort reform - consequently public attention should be focused elsewhere
Again, slightly incorrect. For the most part, tort reform is a debate between insurers, physicians and lawyers who represent victims. The public generally doesn't believe they will ever be injured by negligence, and the victims are focused on their own problems rather than the policy implications. The public is far more concerned about health coverage than recovering from an accident. Physicians SHOULD care more about other healthcare issues, like the current bills in Congress, but they don't..
"4) the current system is as good as realistically possible AND it is very hard if not impossible to improve it."
Absolutely false. Everything has room for improvement.
"It has not been shown that tort problems are insignificant in their impact on medical cost and quality of care."
Actually, it has. We have had 3 decades of tort reform but you can find little proof that the quality of care has improved or that healthcare is any cheaper in the areas where we have it.
"How can the latter claim that the current system cannot realistically be improved despite its numerous and egregious faults? "
When you start with the assumption that there are numerous and egregious faults, based on little evidence, then you've assumed a position without evidence for that position.
" Have lawyers made proposals that will improve and speed up compensations for victims and reduce litigation?"
"Matt is asking doctors for proposals that will improve and speed up compensation for victims at lower administrative cost. "
No, I'm saying if you believe those are problems, propose solutions for that, don't just arbitrarily cap cases by plucking a lobbyists' number out of the air, regardless of merit. The truth is, you can't make insurers pay faster, or run any leaner.
The lawyer has no ability to force an insurer to pay money faster. Now, the lawyer can advocate for more taxes for more judges so cases can be heard quicker, and I think where you find overloaded dockets you may well find that, but it's a very localized issue since counties fund their courthouses, and the states pay the judges. So perhaps lawyers should be advocating for higher taxes for that - which may be a very valid criticism. In my own jurisdiction cases move rather quickly.
"Many lay people believe it makes sense to have lawyers write the laws. That is the problem and that is contrary to the citizen-lawmakers our frames envisioned."
ReplyDeleteWriting laws and making laws are two different things. With respect to writing laws, it makes sense to have people with legal training write them, because they are more likely to have the training in drafting. However, making laws is not, and has never, been exclusively the province of lawyers. These days it's purely a function of cash, at least on the federal level, and every group has its own laws it pushes.
What's more, in the med mal context, there is minimal statutory law. It's a common law negligence action dating back to before our founding.
" We are allowing for a special interest group to write regulations and laws about their service."
This is a silly argument, for a couple reasons. One, it assumes that everyone with a law degree has the same self interest and political outlook. Most of your legislators with law degrees never practice law, or if they did it's in the criminal context as prosecutors or for major law firms representing insurers and Fortune 500 companies. They are far more likely to favor physicians and their insurers than individual plaintiffs in personal injury claims. In fact, there are more physicians in the US Congress than there are attorneys who ever represented individuals in PI claims. Second, it assumes all lawyers have common interest. Given the vast number of areas of the law, this is simply ludicrous. An attorney who does business transactions or estate planning and never sees the courtroom has about as much in common legislatively with a criminal defense lawyer as a physician does with a truck driver. Their paths simply never cross. To assume that they are all united in some cabal is black helicopter thinking.
" Matt, I suggest you put on a pair of jeans and a t-shirt and go visit 4 or 5 contingency lawyers about some made-up grievance you have (just to prove it to yourself). See what they tell you and how they refer you to unscrupulous experts - all to in effect extort a settlement from an insurance carrier"
This is one of the funnier things you've written. You're a physician, do you not deal with insurers? Do you think they just pay claims simply because someone asks and they have a lawyer? If so, can you please tell me which insurers they are? Who are these insurers who are incapable of sorting good claims from bad and are scared shitless of juries that they settle anytime a lawyer is hired.
You seem to have some beef with contingency fees, as most docs do. But tell me, how do you propose a person who is just getting by, and gets hurt because of someone else's negligence, or even a business owner screwed on a contract who is now in the hole, how do you propose they pay for litigation against a well insured or well funded defendant?
"" Matt, I suggest you put on a pair of jeans and a t-shirt and go visit 4 or 5 contingency lawyers about some made-up grievance you have (just to prove it to yourself). See what they tell you and how they refer you to unscrupulous experts - all to in effect extort a settlement from an insurance carrier""
ReplyDeleteIncidentally, I do take cases on contingency fees, regularly. What the person is wearing has no bearing on whether I take the case.
The only time I refer people with an injury to a physician is in a situation where they have no money and I will look for a physician who will treat them on a medical lien. But even that has to be a pretty good case or the doctor won't see them. Generally, I prefer to have the treating physician as the witness to medical damages, because I know what defense lawyers do to "unscrupulous" experts.
I would go broke very quickly if I were to count on insurers settling easily and quickly based on experts that I knew wouldn't stand up at trial under cross. It just makes no financial sense. And it doesn't make sense for the insurers, who don't make money by PAYING claims.
And I'm sure you're thinking well you're just trying to hit a "jackpot". "Jackpot" cases, with 7 digit settlements and verdicts, generally involve devastating injuries and clear liability, if not punitive damages. They are not regular occurrences.
Even with clear liability, no insurer rolls over simply because you make a claim. In cases with large dollar damages and clear liability, insurers are still going to work the case up before they pay.
as a physician, i'm definitely on your side of this argument...
ReplyDeletebut it's probably worth considering that like any other profession, there are good and bad lawyers... and they are probably not all subhuman pieces of shit that troll around from one medical blog to another posting things with the intention of riling up frustrated doctors.
just a thought.
To my anonymous commenter above, I agree with your point. However, I believe that the system itself is unfair against the medical profession and others. So, even an upright attorney is functioning in an unethical arena. Therefore, the resultant work product will be tainted. Lawyers are not to be unfairly blamed for following the rules. We need new rules more than we need new lawyers.
ReplyDeleteIt's easy to assume everyone is "pieces of shit" or that the system is "unethical" when you believe solely in your own interpretation and can't imagine how anyone could disagree.
ReplyDeleteAs the likely "piece of shit" being referred to, I have to say that the more doctors spew their vitriol the happier it makes me that in the very near future they will be simply government employees. At least we won't have to pay them so mightily for their arrogance and they can spew it at the Dept. of Health and Human Services or whichever agency will be running their show.
ReplyDeleteIt will probably not be great for patients, but hey, they won't treat lawyers anyway. And at least the people injured by malpractice won't have to worry about being uninsurable.
And it's almost humorous how angry they get and how much time they spend on malpractice issues when all their reforms don't result in anything more than insurance company savings. Meanwhile, the federal government's tentacles close ever tighter around their industry.
I would like to plead with all commenters on this excellent blog to express their opinions in a polite and civil manner. I believe that comments that could not be printed in a newspaper detract from the blog quality and could repulse readers.
ReplyDeleteA comment by a physician that I have in mind is very accurate in its characterisation of submissions from Matt. Yes, his comments are made to rile not only doctors, but all readers looking for an unbiased and honest discussion. But no matter how justified are one's reactions, it would be best for this blog if they were expressed diplomatically.
Matt does make other interesting and valid points, e.g., a potential trend towards nationalized medicine.
I very much hope that MDWhistleblower will join me in my plea.
Above comment fully endorsed. As a gastroenterologist, I know more about the coarse description repeated in the above comments than anyone else appearing on this page. Surely,the erudite commenters can refrain from gratuitous epithets. Let's raise the bar of decency a little higher.
ReplyDeleteI think that there are valid points both for an against tort 'reform' in this blog. The disconnect to me seems to be that there 'has' to be a bad guy and a good guy (for want of a better analogy). In a malpractice case, what becomes of the doctor named who is not liable? They still have to come up with the money for a defense in a case that they should not have been named in to begin with. (I do not mean a case where they were the patient's doctor and the court found them not liable, I mean those that get added to the list of named defendents and are not liable in the end). Those are the ones I wonder about. There is more than one example of that out there. A recent article talked about an ED doctor that killed themselves just before he was found not liable (but not before going broke defending himself). What of those? Why are they named in cases that should (IMHO) involve the patient and the doctor that cared for them....to name the coroner in a case seems to be a stretch...as far as the care being questioned.
ReplyDeleteAnd there are medical things that could be done differently out there to save costs to payers (patients and/or insurance). Someone has mentioned using one form for ALL insurance company's claims. Instead of 100s of forms and all that wasted time filling out many different types of forms, one set form would save time and staffing. There are probably lots of other things out there that could be done...but to throw the baby out with the bathwater won't save anything in the end.
Thanks for reading.
"In a malpractice case, what becomes of the doctor named who is not liable? They still have to come up with the money for a defense in a case that they should not have been named in to begin with."
ReplyDeleteThey come up with no money out of their pocket. And if a doctor wants out quickly and cheaply, they can volunteer for a deposition early. The reason they are named is often because you are facing a short statute of limitations and it's not clear who is responsible for what or who will blame the others so you can't risk leaving one out prior to knowing all the facts.
Not to say some lawyers don't shotgun file. There are bad apples in every bushel. If they do, then they should be sanctioned.
this guy is happy he makes doctors angry? how can anyone take his defense of his profession seriously? let's see, he benefits handsomely from the misery of others, is anti-doctor, and likely makes more money than doctors who sacrificed their youth and put themselves in huge debt to take care of the health of others. okay, the status quo sounds terrific as far as medical malpractice is concerned! give me a break.
ReplyDeletefair enough, i apologize for my use of profanity. i do find it odd, given that your point is that these people cannot be argued with, that you are continuing to have this "debate" with him on your own blog. why not delete his posts before they even appear?
ReplyDeletecome to think of it, i think for now i'll just stick to sermo where topics like this can be discussed and the parasites have no voice. i mean i like a good, well argued debate but this guy doesn't seem to understand that being good at debating and being impossible to debate with are not the same thing. the latter, for example, is like a christian and an atheist arguing about the existence of god.
More delicate language appreciated. I think its to the blog's advantage to have as many sides of an issue represented as possible. I don't agree with Matt, and have disagreed with him here and elsewhere, but his view is not an abberation. An entire profession and others sympathize with his opinions. While Sermo is a great site, I hope you'll keep us in mind as well. Remember, many folks read the comment sections without writing any of their own. Why deny them your views? I suspect that if a fair minded person read through the above comments, that they would reach an interim conclusion that you and I would be comfortable with. It would not be fair, however, to 'stack the deck' in our favor. We don't need to; we're already on the right side of the issue.
ReplyDeleteIt's fitting that the owner of this blog deals with sh-t. The stuff is a very, very real substance and must come out. This is its sole purpose.
ReplyDeleteI see that this blog has constipated itself by being corked.
Let's get back to the issue and get some laxative action going. We don't want to get cancer.
"I am a poor doctor, frightened by the prospect of litigation, and it is for this reason, and this reason alone, that I might order an unecessary test/hospital stay/medication."
ReplyDelete"Furthermore, as much as it pains me, I have had to turn away 'high risk'patients because of this fear. Don't ask me how I knew they were 'high risk' without seeing them."
Scenario: Patient comes in with an ailment, the Doctor thinks the cause is most likely X but there is a certain per cent chance the cause is Y. What is the cut off point for ordering the test for Y? 50%, 25%, 10%, 5%, 1%? It's like BlackJack, every player has a different 'hit me' number. Anyway, Doc thinks Y might be 10% and goes ahead and orders the test because 1)"what's the harm" and 2)"You never know" and 3)The patient's insurance covers the test and 4)"If it turns out to actually be Y, I've learned something and I've won a patient for life and MAYBE 5) "If I don't order the test for Y and Y kills the patient, I might be sued."
A couple months later, the Doc gets this survey which asks him if he's ever ordered a test for 'defensive reasons' and he remember's "Yeah, I did for that guy." Forget that it wasn't his primary reason, saying it was defensive is the only choice that might lower his malpractice insurance and/or get him additional legislative protections from lawsuits. Gee, what's he gonna pick?
Not all doctors are alike and the same for lawyers. The problem is trying to sort who, what, and why. In that process people can lose more when their physical well being is at stake, such as life itself. People can also end up in jail but usually the first hope is to stay alive. People expect high marks from doctors, including character. People expect high marks from lawyers but lawyers get more jokes. In other words, medical is not often a laughing matter.
ReplyDeleteWith so much territory to cover I have one thought to offer. If someone falls down the wet steps at the lawyer's office and has a number of injuries, wouldn't the doctor feel required to inform, treat and properly document patient findings? Whatever happens to a person during medical the lawyer tries to determine the legal aspects and inform the client.
Whether a doctor patient or a lawyer client in both instances the informed patient should decide whether or not treatment and the informed client decides whether or not to take legal action.