The Health Care Bill has passed...

[Kevin]

Originally Posted by AOII Angel

I thank you for explaining why this happens. Now, why don't they fix this. Just like with medicine, saying that "It's always been that way." doesn't make it right. The malpractice insurance premiums have driven a lot of physicians out of practice in states like Mississippi and West Virginia. OB/GYN and Neurosurgery can be cost-prohibitory to practice.

Trouble is, the only folks really shilling methods of 'fixing things,' are just shilling means to enriching their respective constituencies, not actually fixing anything, and in many cases, making things worse.

Obviously, there must be disincentive built into the system to keep docs from performing open-heart-surgery while tripping on painkillers (it happens). And the 'driving folks out of business' argument just doesn't play well with me. They tried that argument recently in my state, but ignored the fact that while some practices did close, more practices opened in their place, meaning that there was a net-gain in the number of practices opening. It's pure speculation on my part, but I imagine that's the case in Mississippi and West Virginia as well. Unfortunately, the 'tort reform' side of the argument relies a lot on what can objectively be called misinformation or outright falsehood. They don't want an honest answer, they just want to increase their clients' (not doctors, but malpractice insurers) bottom line.

Case in point, take any of the states which have passed major medmal reform legislation, e.g., Texas. Their rates continued to climb in lock-step with the rest of the industry (but of course, the insurers ended up with a lot more cash than before).

Docs, I think, are too quick to blame the legal system for their malpractice insurance rates. They might instead look to the folks who they keep writing those big checks to (hint: not lawyers).

I have to disagree with you here. The use of radiology services has jumped astronomically in the past 5 years with CT imaging increasing more than 60% since I started residency. This has actually decreased physicians' ability to utilize physical diagnosis (hands-on examination) skills which are FREE in exchange for high cost CTs which have a very REAL risk of CANCER! If you look at my PACS system (radiology archival system) there are patients that come to my ER that have had abdominal CTs for abdominal pain every month for 10 months that have NEVER found a single abnormality. That is $30,000 worth of medical imaging to cover an ER doctors butt that has provided to patient with over 1,000 x-rays worth of radiation. Not a good idea. More expensive is not always better!

I think I must have heard a study confirming that on NPR recently. But I don't see any way around that short of some sort of medical tribunal actually putting out standards for that sort of care. While that, absent a statute, probably wouldn't bind a court, part of what goes into winning a medical malpractice case is proving by a preponderance of the evidence (or more depending on the state) that the physician violated the standard of care. If all physicians had some sort of guidelines as to what would and wouldn't violate that standard, maybe they could get away from defensive medicine. I'm not an expert in that field, but something like that would probably have some serious pull if physicians would actually stick to those rules more-less.

What I definitely don't think should happen is that bad doctors get insulated from practicing bad medicine.

[AOII Angel]

Originally Posted by Kevin

What I definitely don't think should happen is that bad doctors get insulated from practicing bad medicine.

I'll agree with you here. Unfortunately, the bad doctors aren't always the ones getting sued. I know some scary cases that would make your hair curl, and I doubt anyone would sue the physician involved. There are many factors into why people sue, and it's rarely the actual malpractice involved. The doctor must have amazing bedside manner (I can't imagine because his interpersonal skills seem non-existent) because nothing seems to stop his parade of poor care. I think what we do need is a set of standards that we are required to follow, but it will never pass until the older generation of doctors stop practicing medicine and the old paternalistic standard is completely abolished. It would also be nice to have more educated people evaluating these cases since determining what meets standard of care is not exactly at the level of the lay public. Otherwise, I am on board with a lot of what you say, Kevin, I am often sickened when blatant malpractice is ignored and physicians continue to practice the same bad medicine over and over again.

But I don't see any way around that short of some sort of medical tribunal actually putting out standards for that sort of care. While that, absent a statute, probably wouldn't bind a court, part of what goes into winning a medical malpractice case is proving by a preponderance of the evidence (or more depending on the state) that the physician violated the standard of care. If all physicians had some sort of guidelines as to what would and wouldn't violate that standard, maybe they could get away from defensive medicine. I'm not an expert in that field, but something like that would probably have some serious pull if physicians would actually stick to those rules more-less.

This is what is wrong with medicine in a lot of ways now days. Medicine is NOT an exact science. When patients come to the ER complaining of cough, fatigue and chills, the ER doctor SHOULD think viral infection, NOT Cancer. Yes, the patient could have lymphoma or leukemia, but these are called Zebra diagnoses. We are not supposed to be chasing after zebras when horses are so much more common. When the patient comes back with the same symptoms a month later, THEN you do the work-up for Cancer. The doctor didn't MISS the diagnosis of cancer. It isn't MALPRACTICE. If we take every single patient with vague symptoms and do multi-million dollar work-ups, we will NEVER decrease the cost of health care in this nation.

[Kevin]

Originally Posted by AOII Angel

This is what is wrong with medicine in a lot of ways now days. Medicine is NOT an exact science. When patients come to the ER complaining of cough, fatigue and chills, the ER doctor SHOULD think viral infection, NOT Cancer. Yes, the patient could have lymphoma or leukemia, but these are called Zebra diagnoses. We are not supposed to be chasing after zebras when horses are so much more common. When the patient comes back with the same symptoms a month later, THEN you do the work-up for Cancer. The doctor didn't MISS the diagnosis of cancer. It isn't MALPRACTICE. If we take every single patient with vague symptoms and do multi-million dollar work-ups, we will NEVER decrease the cost of health care in this nation.

If that's the mentality docs are approaching their craft with, then they really need to get educated on what constitutes malpractice. Missing an obscure diagnosis when more obvious symptoms were presented in an ER setting is almost never going to be malpractice. Doing a CT in that case, or treating anything beyond an acceptable minimum just opens the door to other sorts of medical errors.

Do you think part of this 'defensive medicine' aspect is really that hospitals and certain practices want to conduct as many expensive procedures as possible in order to bill health insurance companies/medicare for more services delivered?

I know that the practice of law is often handled that way -- especially by insurance defense firms. They do an excellent job at billing that file. Most of them bill by the hour, and there's a saying about those guys that you'll never be deposed by an insurance defense attorney. . . because there's never just an insurance defense attorney there. They invariably send 2-3 lawyers (or more) to sit and bill their full hourly rates for listening to another lawyer conduct a deposition... but I digress.

[AOII Angel]

Originally Posted by Kevin

If that's the mentality docs are approaching their craft with, then they really need to get educated on what constitutes malpractice. Missing an obscure diagnosis when more obvious symptoms were presented in an ER setting is almost never going to be malpractice. Doing a CT in that case, or treating anything beyond an acceptable minimum just opens the door to other sorts of medical errors.

Do you think part of this 'defensive medicine' aspect is really that hospitals and certain practices want to conduct as many expensive procedures as possible in order to bill health insurance companies/medicare for more services delivered?

I know that the practice of law is often handled that way -- especially by insurance defense firms. They do an excellent job at billing that file. Most of them bill by the hour, and there's a saying about those guys that you'll never be deposed by an insurance defense attorney. . . because there's never just an insurance defense attorney there. They invariably send 2-3 lawyers (or more) to sit and bill their full hourly rates for listening to another lawyer conduct a deposition... but I digress.

I don't think that physicians are ordering more tests to bill more because THEY don't get to bill more for those tests. It sounds good to lawyers because it works that way for y'all, but it doesn't work that way in medicine. The primary care doctors never see a dime for all of these extra tests. They really do just think they're protecting themselves from being sued. It's more common than you think, too. I've seen it happening at more than one hospital in more than one state, and have friends in other states that have the same experience. Physicians really think that lawyers are out to sue them if they miss anything. It may not be true, but that's the perception.