Greetings from bleeding heart liberal Dr-land (sort of):
The article DocCallaway posted was dead-on. We can't have it both ways, but it is politically incorrect to say so. I have several opinions.
1. Health care desperately needs reform. We can't continue this way. More and more people are uninsured, acuity is higher, physician compensation is waning, cost of education is increasing, doctors and hospitals are getting sued for missing a few zebras, people with tiny life expectancy are on ventilators with fancy lines and other state-of-the-art technology (babies, chronically ill, and elderly alike) while the guy who just needed a freakin' PCP to give him a BP pill or two couldn't get that, but the government is paying for his dialysis and organ transplant.
😕
2. Malpractice is a big part of the problem. BUT I don't know that Mr. Obama is in the wrong yet. We have not given him a chance. He said he would look into it, and I think he's right that limiting awards isn't necessarily the best solution. Look at what pseudoknot posted, and I think it's true. If I get my ass hauled into court and am told I f*cked up by following EBM and not CT scanning someone and they win 20K instead of 100K, I am STILL more likely to order more tests, thereby driving up health care costs. And Stitch is right, it's easy to get defensive, but it IS partially our fault. Yes, the system pushes us but WE allow it to affect our practice despite our better judgment, so some of the blame is OURS.
Personally, I think there are better ideas than limiting awards, and this was the only option he seemed uninterested in. For instance, I think med mal courts are a great idea. If doctors are judged by a panel of their peers patients), it will be the patients seriously injured by true negligence and clear mistakes that will get large awards, while doctors who practiced EBM/true standard of care will walk. The indicting jury would screen out plently of cases before they go to trial, and we could do away with "expert witnesses" to testify for a buck. Instead, the jury would be given access to written testimony solicited from other physicians in the field. There are plenty of ways to do this...
3. End of life care is out of control. 30% of medicare dollars are spent on end-of-life care. It's not the one problem, as there is no ONE problem, but it is a big part of it. I think there is only one solution that makes sense. Expand medical futility. Take it out of the hands of families. They're not comfortable or qualified to make the decision, anyway. I can't tell you how many times the family has tried to turn the decision back to me. The new law would be simple: Physicians who have decided to end life support under the auspices of their hospital's futility committee CANNOT be sued. Also, I think any patient in the ICU for more than 48hrs should be automatically reviewed by the committee.
I remember the healthcare discussion at ACEP. Prez Obama was the only one with a doctor on his committee. So while the beginning has not been perfect (hw could it be coming from Washington with only the AMA involved?), nothing is set in stone yet and we cannot expect to be understood while we stand at a distance scoffing. Let's take this as an invitation to come to the table and try to work with Washington as best we can to reach a better solution. Sitting it out has never worked before, and it won't work now. If you don't have time to actually join an action group or visit Washington, post your thoughts where they will be read by people working on the issue. I'm not saying that discussing (and even bitching and moaning) on SDn isn't beneficial, but it won't change anything. Here is an upcoming opportunity to share your thoughts with the public:
http://abcnews.go.com/Politics/HealthCare/story?id=7845403
