Monday, February 07, 2005

M&M: Med Mal

So a question that up here asks the question: why are malpractice premiums so high? It answers the question by essentially laying the blame on doctors who get many lawsuits against them (something like 5% of doctors are responsible for 40% of lawsuits, but that's from memory) and on high settlements.

Sure, the whole thing boils down to two simple and correctable problems. All we have to do is cap damages through tort reform and have three strike laws for doctors. Yeah right. For one, all those banned doctors will turn out to be neurosurgeons.

Here are my thoughts. Medical malpractice is higher today not only due to high settlements and poor doctors, which are factors of some importance. Other factors simply include the manner in which medicine is practiced today. Problems so entrenched in modern medicine they are impossible to even identify, much less isolate and dig out.

Instead, the truth is that every aspect of medicine sets up malpractice. For instance, when I see a patient, I try to think only about that patient, but still, in a typical resident clinic, that patient gets 5 to 10 minutes of my attention.

Less time spent with the patient, less connection, less of a professional relationship. That's the medical reality these days. You cannot spend more time with patients because you're clearing 20 dollars per patient after overhead, so you have to see more patients per unit time and then actually increase that time. Less time, more hassled dctors. It's easy to connect the dots: more hassled and disatisfied patients who are more likely to sue.

Add in the fact that people now regularly expect medical miracles, recoveries from comas are common on TV. The entire culture is changing. And changing, from both doctor and patient perspectives, very much for the worse.

6 Comments:

Blogger marybishop said...

Also, a point to ponder, insurance companies are ruining what is left of health care today. Just getting a doctor's appointment is a Herculean feat.

I have no doctor - too hard to get one. If I am really, really sick, I go to a walk-in clinic.

Why? Because my new insurance, for example, won't let me call up a dermatologist to get an appointment to have my rash looked at. Oh no,I need permission from my primary care physician.

I don't have a primary care physician, because first, in order to get one, I have to see if they are accepting patients. Many are not. This leaves you with the choice of one doctor whose office is 30 miles away.

Then you have to call to make an appointment with this one approved and accepting-patients primary care physician ( you can wait months to get the appointment) and HE or SHE is the one who then can refer you to the specialist you wanted to see in the first place, providing of course, that physician is on the list of approved doctors.

If you go through all the red tape and do get a primary care physician, they want to test you for everything from MRSA to malaria so that they won't get sued.

You end up having tests you don't need, pain you don't need and worry you don't need.

In the mean time your rash goes untreated until you find an herbal remedy site on the internet and buy a few salves infused with rosemary or tree oil and fix it yourself.

1:02 PM  
Blogger Doc NOS said...

Most PCPs can diagnose and treat common rashes. You don't need to go to a specialist for every condidtion under the sun.

It's interesting to me that you expect to go to a specialist for problems like rashes. When you have to see your PCP, then you get unhappy, yuor doctor knows you don't want to see her, she gets unhappy. In modern medicine, no-one is happy. This lack of happiness with the services provided by the system is contributory to the lawsuits that arise when things go slightly askew.

4:36 PM  
Blogger marybishop said...

I'm sorry, I guess I didn't make myself clear.

The talk about rashes was hypothetical. I certainly don't expect to see a specialist about a rash, (although there are many rashes that need a specialist as in Stevens Johnson Syndrome, for example, which is often misdiagnosed by non-specialists).

As I said, I do NOT go to the doctors anymore - I go to a walk-in clinic instead.

My last PCP (long time ago) was a rheumatologist. He was the only local doctor accepting new patients and wouldn't attempt to diagnose anything out of his realm of rheumatology.

His office was simply a patient mill where you paid your money for the privilege of going somewhere else.

I find your statement very interesting: "When you have to see your PCP, then you get unhappy, yuor doctor knows you don't want to see her, she gets unhappy."

I don't believe that a professional should ever give a whit if someone is "unhappy" to be using their services whether it's a doctor, dentist, lawyer or personal trainer.

In this respect physicians are no different than beauticians. You offer a service and someone chooses to pay you for your expertise. Happiness is not a part of this equation, a nice bonus if you like your diagnosis or your hair-do, but certainly not necessary.

Doctor Nos, you seem very negative to me.

I sense that your dislike of malpractice suits has vitiated your view of patients in general. You certainly display a tone here that shows a lack of respect for your patients aka clients.

I think there would be less suits when things go "slightly askew" as you put it, if there were more equality in the doctor/patient relationship.

Doctors are service providers plain and simple. So many of them today want to wear their ermine robe and crown and have forgotten that the patient is paying you, not the other way around.

I say this because my previous comment was against insurance companies that have contributed greatly to this new subpar health care we now enjoy in the USA.

Think of it, insurance companies are telling you what drugs you can prescribe, this is totally ludicrous.

But you choose to take my statement and imply that it is my fault if I would prefer to skip the PCP and go directly to the person most able to help me with my hypothetical problem. (Remember, there are other insurances that allow you to call up a specialist's office and make an appointment without a glitch.)

The big bad wolf in this equation is certainly not the patient and not the doctor as much as it is the insurance companies that have you dangling on strings like a puppet and worse, scared to death of a malpractice suit so that you alter your patient protocol to CYA.

One last point, since you seem to be shocked that someone would want to see a specialist in the field of which they are in need, I wonder what you would do faced with a malpractice suit? Would you call up your wife's brother-in-law who's a real estate lawyer or a hot-shot divorce attorney?

No, you would seek out the professional best suited to your particular need, which of course would be an attorney well skilled in malpractice suits.

4:53 AM  
Blogger Doc NOS said...

"The talk about rashes was hypothetical. I certainly don't expect to see a specialist about a rash, (although there are many rashes that need a specialist as in Stevens Johnson Syndrome, for example, which is often misdiagnosed by non-specialists)."

This is probably the single rash that most PCPs could diagnose. That and psoriasis.

"As I said, I do NOT go to the doctors anymore - I go to a walk-in clinic instead."

Who staffs that walk-in clinic? DOs are still doctors. PAs report to doctors.

"I don't believe that a professional should ever give a whit if someone is "unhappy" to be using their services whether it's a doctor, dentist, lawyer or personal trainer....Happiness is not a part of this equation, a nice bonus if you like your diagnosis or your hair-do, but certainly not necessary."

You undervalue happiness. That's sad.

"In this respect physicians are no different than beauticians. You offer a service and someone chooses to pay you for your expertise."

The client does not pay, other than a trivial co-payment. Third party payers pay - and you pay them if you have insurance. In this regard, they choose to go into business with the physician.

"Doctors are service providers plain and simple. So many of them today want to wear their ermine robe and crown and have forgotten that the patient is paying you, not the other way around."

Again, this reveals fundamental misunderstanding of health care finances. Patients do NOT pay us. If that were the case, we'd wear bell bottoms, or at least skinny ties.

"Think of it, insurance companies are telling you what drugs you can prescribe, this is totally ludicrous."

It makes sense when it's between trivial differences (who cares what brand of statin or ACE?) and it's much more the case in other countries. In Canada, expensive chemo drugs simply are very often simply not offered.

"But you choose to take my statement and imply that it is my fault if I would prefer to skip the PCP and go directly to the person most able to help me with my hypothetical problem. (Remember, there are other insurances that allow you to call up a specialist's office and make an appointment without a glitch.)"

I choose to find it odd that you wouldn't be happy to see a PCP for a problem she could probably diagnose without further need of a specialist. I find it odd that you expect this.

"The big bad wolf in this equation is certainly not the patient and not the doctor as much as it is the insurance companies that have you dangling on strings like a puppet and worse, scared to death of a malpractice suit so that you alter your patient protocol to CYA."

? This is an equation? The med mal insurance company? They hardly have anyone dangling on strings. We enter a business relationship with them. They actually allow doctors to practice with much less fear. Oh yeah, guess who pays for medical malpractice? It comes off of our bottom line, but most of the costs get passed on to you.

"One last point, since you seem to be shocked that someone would want to see a specialist in the field of which they are in need, I wonder what you would do faced with a malpractice suit? Would you call up your wife's brother-in-law who's a real estate lawyer or a hot-shot divorce attorney?"

False analogy. Again, amazing lack of understanding. Who do you think handles the malpractice suits? Don't you think the insurance companies have an interest? Do you suppose they have some lawyers on retainer? Perhaps...

If I got sued, I'd let the insurance companies handle it.

10:13 AM  
Blogger marybishop said...

I could go tit for tat on each point but I'll stick to a few:

Read my last paragraph and then read your last two paragraphs which are saying the exact same thing: Insurance companies employ the best malpractice attorneys.

You say patients pay you a mere pittance - a co-payment, then go on to say how insurance companies pay you and patients pay them. A semantic merry-go-round and you know it.

When I said I don't go to the doctors, I thought my meaning was clear, but I will make it clearer. I do not call up a PCP and go to him/her to get permission to go to another doctor who's on the insurance company's list. I go to a walk-in where obviously it is staffed by doctors and not by accountants nor mortgage underwriters.

As for Steven Johnsons Syndrome, just put it in google and you can read all the stories of people who suffered for months before a specialist or a team of specialists diagnosed them correctly.

12:04 PM  
Blogger Doc NOS said...

"Read my last paragraph and then read your last two paragraphs which are saying the exact same thing: Insurance companies employ the best malpractice attorneys."

Remains a false analogy.

"You say patients pay you a mere pittance - a co-payment, then go on to say how insurance companies pay you and patients pay them. A semantic merry-go-round and you know it."

But it makes all the difference, and it's not just words. Again, if you understood how this actually impacts health care, you probably wouldn't have posted. Since you pay no matter what you use, your money is many levels of efficiency away from receiving a service. When you and your doctor make decisions regarding your health care, cost does not enter into the equation, and this is wrong. The fact that patients do not pay for their health care directly accounts for much of the bloat in medicine today. The fact that all of this makes medicine non-competitive also adds to the bloat, which we all pay for.

"When I said I don't go to the doctors, I thought my meaning was clear, but I will make it clearer. I do not call up a PCP and go to him/her to get permission to go to another doctor who's on the insurance company's list. I go to a walk-in where obviously it is staffed by doctors and not by accountants nor mortgage underwriters."

So you go to doctors.

"As for Steven Johnsons Syndrome, just put it in google and you can read all the stories of people who suffered for months before a specialist or a team of specialists diagnosed them correctly."

Anecdotes are powerful evidence. Oh, no they're not.

12:23 PM  

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