Obama Says We Don't Need Tort Reform

[TrumpetDoc]

I'd also like to see utilization patterns specifically for EM in TX. All the hubbub studies I am seeing for costs/Tort reform deal with the system as a whole and not put particular field, where many choices are made and risks are stratified not only for the pts outcome, but potential legal implications.

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[FSU2013]

Separation of church and state FTW. That'd be state, at all levels.

I'll cross swords with you on this one. "Will of the people" is proving to be an unsustainable position these days.
See also: The majority of people who can vote... can't demonstrate an understanding of the issues or process.

While I agree with your principle, ie the mob is fickle and poorly informed, I also feel it's a lot more likely that the majority of Americans can give an informed position on things like the legalization of marijuana than they can explain the implications of an increase in the capital gains tax. I think the electoral college, in it's original form, made a lot of sense. Our country is going to wrong direction in nearly all objective measures, and I don't know that our current system is necessarily going to change that. At the risk of sounding elitist, I understand why only land owners were initially allowed to vote. As a corollary, it seems reasonable that today only those that pay taxes should get a vote. Unfortunately, the country is not filled with people that put country before self and will always vote for themselves over the good of the country. For example, many of my classmates were extremely upset with the ending of subsidized loans - our country is bankrupt and it's not their role to pay for our medical education. Even highly educated people wanted to get their slice of the pie and felt slighted that some good or service provided by the government was taken away.

 

[southerndoc]

D mal

Med mal laws vary tremendously between states and procedure/diagnostic testing/admission rates don't seem to correlate with Med mal laws. If all the Med mal is driving costs why aren't costs drastically lower in Texas vs, for example, Illinois?

Just found out Georgia's gross negligence clause was sidestepped recently based on the fact that the patient's condition was deemed not a true emergency, so therefore gross negligence didn't apply.

Patient was seen by a PA in a fast track area for leg pain. Had a DVT ultrasound that was negative. Pulses were documented in both extremities. ABI's were not performed. Patient came back with ischemic legs and lost both legs. Because the patient was sent to a fast track area of the ED and was discharged, the plaintiffs argued the emergency providers didn't think the patient was emergent and therefore gross negligence didn't apply. End result? Plaintiff got $5 million.

Source: http://georgiaplaintiffslawyer.blogspot.com/2012/09/misdiagnosis-resulting-in-leg.html

The law is quoted in that link and it states that patients presenting to an emergency room are held to gross negligence standard. I'm hoping this verdict is overturned in appeal as it states a precedent for future claims for anything not deemed an emergency. Get admitted, it's an emergency. Go home, it's not an emergency. I am currently drafting legislation with the help of several state legislators to improve tort reform in Georgia.

 

[WilcoWorld]

Just found out Georgia's gross negligence clause was sidestepped recently based on the fact that the patient's condition was deemed not a true emergency, so therefore gross negligence didn't apply.

Patient was seen by a PA in a fast track area for leg pain. Had a DVT ultrasound that was negative. Pulses were documented in both extremities. ABI's were not performed. Patient came back with ischemic legs and lost both legs. Because the patient was sent to a fast track area of the ED and was discharged, the plaintiffs argued the emergency providers didn't think the patient was emergent and therefore gross negligence didn't apply. End result? Plaintiff got $5 million.

I am currently drafting legislation with the help of several state legislators to improve tort reform in Georgia.

 

[RustedFox]

While I agree with your principle, ie the mob is fickle and poorly informed, I also feel it's a lot more likely that the majority of Americans can give an informed position on things like the legalization of marijuana than they can explain the implications of an increase in the capital gains tax. I think the electoral college, in it's original form, made a lot of sense. Our country is going to wrong direction in nearly all objective measures, and I don't know that our current system is necessarily going to change that. At the risk of sounding elitist, I understand why only land owners were initially allowed to vote. As a corollary, it seems reasonable that today only those that pay taxes should get a vote. Unfortunately, the country is not filled with people that put country before self and will always vote for themselves over the good of the country. For example, many of my classmates were extremely upset with the ending of subsidized loans - our country is bankrupt and it's not their role to pay for our medical education. Even highly educated people wanted to get their slice of the pie and felt slighted that some good or service provided by the government was taken away.

That sounds great, if you can just get most everyone to acknowledge that:

" 'cause the Bible says so."

isn't a valid argument... and that social issues need to be debated/criticized/upheld on only objective reason, rational thought, and verifiable reality.

Then sure, we can let social issues (like, who pays for birth control ? who writes the law on abortions ? Should religious organizations be tax exempt ?) be debated in a court of common opinion.

After all, you get enough "Holy Men" together who share a common opinion, you'll get the idea that epilepsy is a result of "demonic possession" and its sufferers should be stoned to death, before the demon has a chance to "turn" anyone else.

If you want real talk about real issues... make it just that. REAL talk. No more mysticism and dungeons and dragons nonsense.

 

[RustedFox]

Just found out Georgia's gross negligence clause was sidestepped recently based on the fact that the patient's condition was deemed not a true emergency, so therefore gross negligence didn't apply.

Patient was seen by a PA in a fast track area for leg pain. Had a DVT ultrasound that was negative. Pulses were documented in both extremities. ABI's were not performed. Patient came back with ischemic legs and lost both legs. Because the patient was sent to a fast track area of the ED and was discharged, the plaintiffs argued the emergency providers didn't think the patient was emergent and therefore gross negligence didn't apply. End result? Plaintiff got $5 million.

Source: http://georgiaplaintiffslawyer.blogspot.com/2012/09/misdiagnosis-resulting-in-leg.html

The law is quoted in that link and it states that patients presenting to an emergency room are held to gross negligence standard. I'm hoping this verdict is overturned in appeal as it states a precedent for future claims for anything not deemed an emergency. Get admitted, it's an emergency. Go home, it's not an emergency. I am currently drafting legislation with the help of several state legislators to improve tort reform in Georgia.

This is also a perfect case of the MD/DO being used as nothing but a liability offset. Can't have it happen, man. Pulses present = no "cold leg" at the time of the exam. Happened after being sent home.

 

[southerndoc]

This is also a perfect case of the MD/DO being used as nothing but a liability offset. Can't have it happen, man. Pulses present = no "cold leg" at the time of the exam. Happened after being sent home.

Were pulses really present? If the patient loses their legs from ischemia, a good attorney could argue that the physician never felt for pulses, felt his/her own pulse (it's happened to me before), etc. Documenting a patient having pulses and then having them lose their legs from ischemia 6 hours later is suspicious.

I've got to where anytime I order a DVT ultrasound or someone comes in with non-traumatic limb pain, I usually ask for ABI's.

 

[deleted109597]

Were pulses really present? If the patient loses their legs from ischemia, a good attorney could argue that the physician never felt for pulses, felt his/her own pulse (it's happened to me before), etc. Documenting a patient having pulses and then having them lose their legs from ischemia 6 hours later is suspicious.

I've got to where anytime I order a DVT ultrasound or someone comes in with non-traumatic limb pain, I usually ask for ABI's.

This can't possibly be evidence for defensive medicine.
Although, ABIs aren't expensive. Our residency hospital would tell us that nurses weren't allowed to measure them though, so it was a pain to get them (ie, find the manual cuff, the working doppler, etc).

 

[docB]

I would definitely be considered "the religious right" - even still, I would happily vote for a fiscal conservative that is a social moderate. I think the two (fiscal and social issues) should not be inherently coupled, instead I think people should run on their fiscal platform and allow social issues to either be a states' rights issue (preferred) or govern based on the will of the people.

I think we have reached the point where more people on the left vote primarily for social issues. Most of us on the right choose financial issues.

 

[Perrotfish]

I think we have reached the point where more people on the left vote primarily for social issues. Most of us on the right choose financial issues.

You might feel this way because you, as a physician, know a relati rely richer subset of both conservatives and liberals. Conservatives still have a strong base of lower middle class Americans who certainly aren't voting with their financial interests when they vote Republican.

 

[docB]

You might feel this way because you, as a physician, know a relati rely richer subset of both conservatives and liberals. Conservatives still have a strong base of lower middle class Americans who certainly aren't voting with their financial interests when they vote Republican.

I see your point. I disagree that a lower middle class person will do better under liberal fiscal policy. Conservative fiscal policy creates economic growth and and everyone does better.

Your argument that the lower middle class is more likely to vote primarily on conservative social policy may be correct. I just think that we have reached the tipping point where that segment is outnumbered by those who vote left on social policy. By the time you add in gay rights, immigration amnesty, abortion, socialized medicine and so on you've got a lot of people supporting the left.

 

[GeneralVeers]

You might feel this way because you, as a physician, know a relati rely richer subset of both conservatives and liberals. Conservatives still have a strong base of lower middle class Americans who certainly aren't voting with their financial interests when they vote Republican.

Those lower middle class voters only do worse under Republicans if you assume that they benefit more from government programs, than they do from having lower unemployment (and theoretically a better-paying job).

 

[WilcoWorld]

Were pulses really present? If the patient loses their legs from ischemia, a good attorney could argue that the physician never felt for pulses, felt his/her own pulse (it's happened to me before), etc. Documenting a patient having pulses and then having them lose their legs from ischemia 6 hours later is suspicious.

I've got to where anytime I order a DVT ultrasound or someone comes in with non-traumatic limb pain, I usually ask for ABI's.

What are you doing with the ones with an abnormal ABI, admitting them all?

 

[Perrotfish]

Those lower middle class voters only do worse under Republicans if you assume that they benefit more from government programs, than they do from having lower unemployment (and theoretically a better-paying job).

Except that unemployment has gone up the majority of times we lowered the top marginal tax rate, and went down the majority of times we raised it.

http://www.huffingtonpost.com/larry-beinhart/tax-cuts-vs-unemployment_b_792087.html

A more interesting data set is the capital gains rate, which suggests that there is an 'ideal' capital gains tax, but we're below it:

http://www.goldensoftware.com/index2.php?option=com_content&view=article&id=691

 

[GeneralVeers]

Except that unemployment has gone up the majority of times we lowered the top marginal tax rate, and went down the majority of times we raised it.

http://www.huffingtonpost.com/larry-beinhart/tax-cuts-vs-unemployment_b_792087.html

A more interesting data set is the capital gains rate, which suggests that there is an 'ideal' capital gains tax, but we're below it:

http://www.goldensoftware.com/index2.php?option=com_content&view=article&id=691

I'm not reading anything from the Huffington Post. It would be like if I quoted Fox News as a source to support my arguments. Anything they say is suspect.

How about we just drop spending to the historical average of less than 20% GDP, and we raise taxes enough to 20% GDP? Math problem solved!

 

[southerndoc]

What are you doing with the ones with an abnormal ABI, admitting them all?

Severe cases get CTA's with runoff. Moderate cases get vascular consult by phone and outpatient follow-up the next day.

 

[GeneralVeers]

As a slight aside, we can see an experiment happening in California from which we can measure results. This election, Republicans were effectively wiped out of of the State. The Legislature now has the 2/3 supermajority they need to pass any and all legislation, tax increase, and regulation without fear of any Republican opposition.

California is the richest state in the nation, with slightly higher than average unemployment. If Parrotfish and the other Progressives are right, this new experiment in unlimited Progressive government should produce the following benefits:

1. Improved healthcare outcomes
2. Higher employment (per his Huffington Post article whereby higher taxes magically produce more jobs)
3. Lower poverty levels
4. Better school performance
5. Improved roads/infrastructure

It will be interesting to compare the new Progressive(er) California with my own state of Nevada which is Libertarian, less wealthy, has the highest unemployment in the nation, and a Republican governor and legislature. In four years, let's see which of the two states is moving in the right direction.

 

[WilcoWorld]

As a slight aside, we can see an experiment happening in California from which we can measure results. This election, Republicans were effectively wiped out of of the State. The Legislature now has the 2/3 supermajority they need to pass any and all legislation, tax increase, and regulation without fear of any Republican opposition.

California is the richest state in the nation, with slightly higher than average unemployment. If Parrotfish and the other Progressives are right, this new experiment in unlimited Progressive government should produce the following benefits:

1. Improved healthcare outcomes
2. Higher employment (per his Huffington Post article whereby higher taxes magically produce more jobs)
3. Lower poverty levels
4. Better school performance
5. Improved roads/infrastructure

It will be interesting to compare the new Progressive(er) California with my own state of Nevada which is Libertarian, less wealthy, has the highest unemployment in the nation, and a Republican governor and legislature. In four years, let's see which of the two states is moving in the right direction.

Your model is flawed: If government has no effect on the economy, and it's all random, then we would expect each state to regress to the mean. So, in four years the relatively wealthy state will be less wealthy and the poor state will be less poor and your - producing the same results you predict for your "experiment".

 

[docB]

Your model is flawed: If government has no effect on the economy, and it's all random, then we would expect each state to regress to the mean. So, in four years the relatively wealthy state will be less wealthy and the poor state will be less poor and your - producing the same results you predict for your "experiment".

He didn't just throw out wealth as a concept where one state gets wealthier and another less so. He named 5 specific, measurable things we can look at in the future. By not comparing a simple GDP figure but looking at unemployment, infrastructure, etc. we should be able to compare the relative success or failure of each agenda over a short term.

Veers- You know that the reason the Progressive agenda will have appeared to fail to myopic barbarians such is you is that they will not have been given enough time and latitude to do what they really wanted to do. Socialism never fails on its own merit. It fails because it's never done enough.

 

[glorfindel]

Ectopic hit it on head....
I don't even want to be "named".
I realize there can, and very well may be, instances were this is just out of my control. However, it's a mindset that I hear a lot..." that would never "go to trial",or "they would never win" etc.

As I understand it, there is almost no correlation between the quality (or lack thereof) of the medicine you practice, and the likelihood that you'll be named in a suit. This is for me one of the strongest arguments for tort reform -- it doesn't lead to lower rates of medical malpractice.

So if you don't want to be named in a lawsuit, what to do?

As I understand it, the available evidence says "don't make the patient mad at you." Patients sue because they were angry at their doc, or because the outcome was bad. They also sue because they can't get good answers to their questions, and hope to use the discovery process to get answers.

None of these reasons, you will note, make good arguments against tort reform.

 

[danielmd06]

He didn't just throw out wealth as a concept where one state gets wealthier and another less so. He named 5 specific, measurable things we can look at in the future. By not comparing a simple GDP figure but looking at unemployment, infrastructure, etc. we should be able to compare the relative success or failure of each agenda over a short term.

Not precisely what either you or Veers are alluding to but I found this interesting:

http://finance.yahoo.com/news/the-best-and-worst-run-states-in-america-150415625.html

 

[GeneralVeers]

Not precisely what either you or Veers are alluding to but I found this interesting:

http://finance.yahoo.com/news/the-best-and-worst-run-states-in-america-150415625.html

Calfifornia should be the role-model for Progressives. They've put in almost all the programs, and regulations that Obama would want. Yet, Welfare has exploded, debt is out of control, the roads are crumbling. The Progessives blame their inability to raise taxes in the past. Now they have the power to raise all the taxes they want, so we'll see if it addresses any of their issues.

 

[danielmd06]

Calfifornia should be the role-model for Progressives. They've put in almost all the programs, and regulations that Obama would want. Yet, Welfare has exploded, debt is out of control, the roads are crumbling. The Progessives blame their inability to raise taxes in the past. Now they have the power to raise all the taxes they want, so we'll see if it addresses any of their issues.

Precisely.

 

[Lokhtar]

Because our current tort system has many deleterious effects on society in general and medicine specifically.

-It has caused doctors to practice defensively ordering more diagnostics and consults than are medically necessary resulting in greatly increased costs and morbidity.

-It has resulted in a jackpot mentality on the part of patients who feel no imperative to be responsible for their own actions or to be active participants in their health care. They assume that if anything bad happens they will get a big pay off.

-It has resulted in greatly increased documentation requirements at every step in healthcare causing huge decreases in productivity.

Studies in states with tort reform have shown that it hasn't decreased costs. I disagree with President Obama, and I think tort reform needs to happen, primarily because the judgments are often very unfair but the cost issue won't work politically because the other side can so easily disprove it with data.

 

[TrumpetDoc]

Studies in states with tort reform have shown that it hasn't decreased costs. I disagree with President Obama, and I think tort reform needs to happen, primarily because the judgments are often very unfair but the cost issue won't work politically because the other side can so easily disprove it with data.

Have there been any specifically looking at EM costs? Advanced imaging utilization? Etc?
The studies I've seen looked at total costs. When docs have biopsy mills, and the like, nothing will keep costs down.

 

[Lokhtar]

Have there been any specifically looking at EM costs? Advanced imaging utilization? Etc?
The studies I've seen looked at total costs. When docs have biopsy mills, and the like, nothing will keep costs down.

That might be true. I'm unaware if the studies in question made any distinction by speciality.

 

[EctopicFetus]

Have there been any specifically looking at EM costs? Advanced imaging utilization? Etc?
The studies I've seen looked at total costs. When docs have biopsy mills, and the like, nothing will keep costs down.

This...

Also

When the CBO looked at those provisions, they concluded that if all states adopted them, malpractice premiums would go down by 10 percent, resulting in direct cost savings to the entire system of 0.2 percent. Another way to look at the numbers is that tort reform could save the federal government's Medicare, Medicaid and other federal health insurance programs $54 billion over 10 years, or $5.4 billion yearly.

Beyond that with the current system it likely would require all states to have a similar system (I oppose a federal tort law and prefer a state by state approach).

A quick example. (Note I think state B is wrong but just using it to illustrate my example)

Say State A has no tort reform a truly malignant state
State B has top of the line tot reform docs cant get sued even if terribly negligent.

The problem is simple as a resident I work in state A where we order lots of CYA tests, admit everyone etc. I finish my training and after struggling realize that I could move to state B and make more money. I practice based on the way I was trained in state B therefore limiting any potential gains.

Anyone who works in the ED understands how much CYA stuff goes on. Between CYA and patient satisfaction you have 2 major drivers of cost at least in the ED.

 

[TrumpetDoc]

I would hope that there are more than I, but I was trained a certain way, but underlying that, we learned good medicine.

I would love to hear from those practicing in, say TX, if they at least feel that they can exercise "clinical" medicine more often that they could in training or another state?


Sent from my iPad using Tapatalk

 

[deleted109597]

I would hope that there are more than I, but I was trained a certain way, but underlying that, we learned good medicine.

I would love to hear from those practicing in, say TX, if they at least feel that they can exercise "clinical" medicine more often that they could in training or another state?


Sent from my iPad using Tapatalk

I live in Texas.
I practice clinical medicine because I think it's important to teach it to the future emergency physicians.

I order significantly fewer CTs than my colleagues. I admit significantly less people.
I cardiovert and discharge "some" a fib and SVT.

However, a large number of the people practicing here started practicing in the "bad" days, and it's hard to unlearn a crutch you lean on. Others come from other states and aren't comfortable with "doing less than I would do there."
Some even argue that if we don't teach defensive medicine, we do the residents a disservice because they'll be more likely to get sued if they leave the state.

So it's tough. But it is doable.


Also, my malpractice is dirt cheap.

 

[UnderwaterDoc]

Yay Texas, another year and a half and I'll be there.

 

[EctopicFetus]

I live in Texas.
I practice clinical medicine because I think it's important to teach it to the future emergency physicians.

I order significantly fewer CTs than my colleagues. I admit significantly less people.
I cardiovert and discharge "some" a fib and SVT.

However, a large number of the people practicing here started practicing in the "bad" days, and it's hard to unlearn a crutch you lean on. Others come from other states and aren't comfortable with "doing less than I would do there."
Some even argue that if we don't teach defensive medicine, we do the residents a disservice because they'll be more likely to get sued if they leave the state.

So it's tough. But it is doable.


Also, my malpractice is dirt cheap.

Precisely my point. I am a low utilizer. I dont order bunches of CTs. Arizona is a decent med mal state I trained here and now work here. I can tell you when I was a student in Chicago there was way more CYA.

 

[JoBreeze]

Arizona has a republican supermajority in both houses, so Cali vs. Arizona. Lets get it on.

 

[EctopicFetus]

Arizona has a republican supermajority in both houses, so Cali vs. Arizona. Lets get it on.

Meaning? whats the fight about?

FWIW AZ twice (maybe more) passed tort reform that was then deemed unconstitutional. We did recently pass a law that helps things.

 

[docB]

Studies in states with tort reform have shown that it hasn't decreased costs. I disagree with President Obama, and I think tort reform needs to happen, primarily because the judgments are often very unfair but the cost issue won't work politically because the other side can so easily disprove it with data.

This...

Also

Beyond that with the current system it likely would require all states to have a similar system (I oppose a federal tort law and prefer a state by state approach).

A quick example. (Note I think state B is wrong but just using it to illustrate my example)

Say State A has no tort reform a truly malignant state
State B has top of the line tot reform docs cant get sued even if terribly negligent.

The problem is simple as a resident I work in state A where we order lots of CYA tests, admit everyone etc. I finish my training and after struggling realize that I could move to state B and make more money. I practice based on the way I was trained in state B therefore limiting any potential gains.

Anyone who works in the ED understands how much CYA stuff goes on. Between CYA and patient satisfaction you have 2 major drivers of cost at least in the ED.

Ectopic beat me to it. The reason we don't see a drop in costs in states with reasonable tort reform is that the "standard of care" has evolved for generations in a hostile legal environment. We've all been taught scan this, admit that. There are better ways but it will be tough to roll back to it. Necessary, but slow and tough.

 

[Lokhtar]

Speaking purely politically, it doesn't make a great political argument that if you pass tort reform, maybe costs will go down in a generation. It may be true, but that's not going to work as a political movement. Also, when legislatures look at 'costs', they usually don't care about ED vs. Outpatient oncology vs. whatever. They care more about the bottom line overall costs. If the result is only that the same fiscal pie is utilized a different way, it doesn't really help the budget problem that they have.

 

[Daiphon]

Speaking purely politically, it doesn't make a great political argument that if you pass tort reform, maybe costs will go down in a generation. It may be true, but that's not going to work as a political movement. Also, when legislatures look at 'costs', they usually don't care about ED vs. Outpatient oncology vs. whatever. They care more about the bottom line overall costs. If the result is only that the same fiscal pie is utilized a different way, it doesn't really help the budget problem that they have.

And thus a large part of the problem; our patients aren't the only ones with an unhealthy preoccupation with instant gratification... the people writing the laws & setting reimbursements are worse than Veruca Salt.

Now if I only had an army of well-trained squirrels... d=)

Cheers!
-d

 

[emd123]

Good points.

 

[Birdstrike]

.

 

[GeneralVeers]

Even if we stopped the lawyers, we still have the problem of patient satisfaction. If I get low enough scores, or enough complaint letters I can be fired from my hospital.

I often order tests, not for fear of lawsuit (because I know there is nothing wrong with some people), but out of fear of a complaint letter.

 

[Birdstrike]

.

 

[ERDude]

Even if we stopped the lawyers, we still have the problem of patient satisfaction. If I get low enough scores, or enough complaint letters I can be fired from my hospital.

I often order tests, not for fear of lawsuit (because I know there is nothing wrong with some people), but out of fear of a complaint letter.

I agree that basing doc compensation or job security on patient satisfaction is total bull**** (unless one was way behind the curve in which he/she is probably doing something wrong), but I also think it is important for most of us (and future community attendings) to keep the big picture of patient satisfaction in mind. That is: if you are friendly and show some basic concern for your patients the vast majority will think fondly of you, and your patient sat scores should be just fine.

Also, it's not that hard to feign it a little bit. I started doing it and I noticed two things: My patients were happier and I too felt better about my encounters. I don't do anything egregious. If the patient or family asks for a blanket or coffee, I'll get it for them (unless crazy busy). At the end of my encounters with nearly all of my discharged patients, I go back, talk to them, explain the diagnosis/discharge plan, and almost universally say "I hope you feel better soon, come back if things get worse so we can recheck you". The patients seem to really appreciate that.

The uber demanding, "I want X, Y, and Z or ELSE" patients are in the minority, but probably won't be satisfied no matter what the hell you do for them, so just chalk it up as a loss. It will even out.

 

[Croooz]

Why Caps Are Not Enough


We don't want to be sued for $50,000,000.

We don't want to be sued for $5,000,000.

We don't want to be sued for a "capped" $500,000.

We don't want to be sued for $5,000.

We don't want to be sued and win.

We don't want to be put on trial, at all!

We went to 4 years of college, 4 years of medical school, 3-9+ years of residency working like dogs with $300,000 in student debt to help people, not to be sued. But reality tells us that no matter how perfect we try to be, how many lives we save, how many long nights we suffer sleepless, that's not an option for us. There's no prayer in hades to prevent it. Our greatest teachers get sued like criminals. Almost every single doctor I know has been sued, and the best just as much as the worst. For what? What do you expect us to do but order tests to be double, triple, a million times "careful"?

Reign in the lawyers.

Reign in the lawyers.

Reign in the lawyers!

Here's the real reason to reign in the sue-happy and their out of control lawyers now: Defensive medicine and the unnecessary tests and treatments that go along with it can really hurt people. This has gone on long enough. There's been enough blood letting. We're done. Don't you get it? We no more signed up to be eviscerated in court for trying to help people than sheep sign up for the slaughter.

It's unbelievable! that we signed up to help people and the same people we dedicated our lives to help allow us to be put on trial like criminals. This, all for spending the best years of our lives in a library to help the sick and infirm in this country. The same attorneys that sue us in court turn right around and seek treatment from the same doctors they've called negligent in front of a jury. I've seen it happen. It's amazing any of us shows up to work. Amazing.

As far as solutions: "Caps, caps, caps." If I hear one more doctor say we should settle for awards caps, I'll explode. When your reimbursements get cut, what do you do? You see more patients to make up the difference. When attorneys' awards get cut what do they do? They file more lawsuits to make up the difference. Caps are a moral victory, but but only go 1% towards solving the problem.

We're at the tipping point. We demand complete immunity for doctors, now.

Now

Makes sense.

 

[Birdstrike]

.

 

[Arcan57]

Makes sense.

No, it doesn't. The premises are sound, but the conclusion is ridiculous. Doctors have done some truly awful things (think wrong site surgeries for one), and complete immunity is indefensible from any standpoint other than the doctors. I could see if advocating for it helped sell a compromise that is more in our favor (I agree about the caps, I think changing the standard to gross negligence is a more effective system). But it's so far outside of anyone's notion of fairness that it's not useful as a starting position.

 

[Croooz]

No, it doesn't. The premises are sound, but the conclusion is ridiculous. Doctors have done some truly awful things (think wrong site surgeries for one), and complete immunity is indefensible from any standpoint other than the doctors. I could see if advocating for it helped sell a compromise that is more in our favor (I agree about the caps, I think changing the standard to gross negligence is a more effective system). But it's so far outside of anyone's notion of fairness that it's not useful as a starting position.

Negotiations have to start somewhere. Complete immunity won't fly but if you guys come to the table from that starting point then you can move toward middle ground. If you already start close to center why bother to negotiate. As you know the reform also needs to include the redonkulous litigation you guys face.

 

[Arcan57]

Negotiations have to start somewhere. Complete immunity won't fly but if you guys come to the table from that starting point then you can move toward middle ground. If you already start close to center why bother to negotiate. As you know the reform also needs to include the redonkulous litigation you guys face.

Starting too far away just means your argument is rejected out of hand. See Republican showing in the last election (were they lost essentially because of their ridiculous initial stance on social causes) or the NHL lockout as examples.

 

[Lokhtar]

Complete immunity no matter what? No one ever is going to take that remotely seriously. The position will simply be dismissed and the discussion will proceed without any physician input at all. And it'll be a great help to people on the otherside, because they can use it to paint physicians in a negative light.

The mistaken assumption there is that there is a 'negotiating table', where two sides come together and hammer out a middle ground somewhere. There is no negotiating table where physicians have a seat. It's going to be one part of the legislature vs. another - and they'll decide it based on what their constituents and lobbyists are telling them. The position of starting with complete immunity is a sure fire way to get nothing at all - the only thing you're doing is making it harder for the people in the legislature who ARE for tort reform to be able to defend you.

 

[Birdstrike]

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[glorfindel]

". . .perhaps physicians would not be led around like lap dogs by lawyers, businessmen, politicians and bureaucrats and told how to practice medicine as we are now. Thank you, for having an open mind.

(emphasis added)

I agree with Birdstrike generally about the need for tort reform.

However I think it's unreasonable to expect that we can ever have the following two things simultaneously:

a) immunity from malpractice suits
b) freedom from being "told how to practice medicine."

If we physicians want to be the decision makers, we are going to be held accountable for our decisions.

Give us immunity from suit and we will likely be reduced to being mere followers of published algorithms or practice guidelines. And that's reasonable.

If I hired an electrician, for example, who was immune from suit if he f**ked up, I'd insist that the guy follow some kind of guideline in order to retain his immunity. Or, I'd insist that he be closely supervised by someone that I could seek compensation from (sue the living sh** out of) if he messed up and caused my house to burn down.

We can have it either way we want it, but we can't have it both ways.

I'd like to be shown to be wrong. If anyone can do it (birdstrike?) please do. I'll walk away with a huge smile on my face.

 

[Birdstrike]

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