The Medical Malpractice Myth

[sgglaze]

The other major point of the article, which I see hasn't been discussed yet, is that since malpractice insurance is a very small piece of the healthcare puzzle (and he also mentions that the increased costs due to defensive medicine are not as significant they are made out to be, though I did not see significant numbers on this in the article) that the much touted remedy of tort reform with more stringent award caps WOULD NOT have the desired impact of significantly lowering the cost of health care.

The other point he tries to make is that the cost of malpractice insurance itself is actually cyclical and therefore tort reform would not have the desired impact on physicians salaries either. I did not see as much as I would like to back this up, other than for him to briefly comment on a similar crisis happening in the early 80s. Maybe the book details this, either way, it's interesting to talk about.

The third significant point he makes is that since tort reform would not have the desired impact on either lowering the cost of healthcare or reducing malpractice insurance for doctors(since that is cyclical and will happen anyway) all that it does is serve to hurt people who were actually injured by incompetent doctors. He also mentions that victims of malpractice usually do not sue in the first place, and when they do sue, doctors usually win.

Perhaps it was my mistake only posting the excerpt, as it's very easy to jump on those two paragraphs out of context, while missing the gist of the whole article.

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[Jejton]

A more accurate comparison would be the percentage of the average driver's income which is spent on auto insurance to the percentage of the average physician's income spent on malpractice.

 

[Jejton]

I think you're a bit mistaken. People don't think that malpractice is the #1 problem in healthcare. People thinking about careers in medicine however often consider it the #1 reason they're hesitant to become doctors.

This should be qualified. Very very few undergraduate students factor in future malpractice costs when deciding on a career choice. Perhaps senior medical students factor it when deciding on a specialty to pursue but if you survey students on any average college campus, I highly doubt you will find more than one or two overachievers who have given it any thought in their decision process.

 

[sirus_virus]

lawyers are scrweing doctors like 8th street ******, and the only thing you premeds and medstudents can come up with is "medmal crisis is a myth". See you in the real world.

 

[etf]

A more accurate comparison would be the percentage of the average driver's income which is spent on auto insurance to the percentage of the average physician's income spent on malpractice.

and then compare the average payout by an insurance company for an auto claim vs. a medical malpractice claim.

 

[Law2Doc]

lawyers are scrweing doctors like 8th street ******, and the only thing you premeds and medstudents can come up with is "medmal crisis is a myth". See you in the real world.

Much like eliminating 8th street ****** wouldn't make a dent in global prostitution, eliminating these suits wouldn't make a huge dent in healthcare. The point wasn't that doctors aren't getting "scrwed", it was that this isn't a big ticket item in our healthcare debacle. The "real world" knows this (which is why most of the voting public isn't pushing to reform things to make life better for the poor doctors, or for ******, for that matter). SDN, for obvious reasons, sees the issue through doctor-centric lenses, which sometimes obscures reality.

 

[Dookter]

Much like eliminating 8th street ****** wouldn't make a dent in global prostitution, eliminating these suits wouldn't make a huge dent in healthcare. The point wasn't that doctors aren't getting "scrwed", it was that this isn't a big ticket item in our healthcare debacle. The "real world" knows this (which is why most of the voting public isn't pushing to reform things to make life better for the poor doctors, or for ******, for that matter). SDN, for obvious reasons, sees the issue through doctor-centric lenses, which sometimes obscures reality.

Thank you, thank you, thank you.

 

[sirus_virus]

Much like eliminating 8th street ****** wouldn't make a dent in global prostitution, eliminating these suits wouldn't make a huge dent in healthcare. The point wasn't that doctors aren't getting "scrwed", it was that this isn't a big ticket item in our healthcare debacle. The "real world" knows this (which is why most of the voting public isn't pushing to reform things to make life better for the poor doctors, or for ******, for that matter). SDN, for obvious reasons, sees the issue through doctor-centric lenses, which sometimes obscures reality.

Sure Law2Doc, it is no big deal. I don't even know where you get the idea that most SDNers are in support of doctors on this issue. I see more people arguing in favor of lawyers here. So much so that I am now considering teaming up with medmal lawyers in the future. No need being on a loosing team.

 

[JacobSilge]

I see more people arguing in favor of lawyers here. So much so that I am now considering teaming up with medmal lawyers in the future. No need being on a loosing team.

sirus_virus, very few people (possibly just the OP) are actually speaking in favor of the lawyers. In fact, you bring up a very good point that lawyers aren't the ultimate cause of the malpractice problem for physicians. Their "expert witness" MD's are since all suits would be considered legally frivolous without their complicity. Moreover, I think you are missing the main point that insurance companies, big pharma, reliance on expensive technology, and government policies would be doing a good enough job to screw up the system without the lawyers involved. They're just making a bad situation worse as a whole. The problem lies in the fact that their cost to the system is borne almost entirely by the doctors whereas the rest are borne by the system as a whole.

However, I have to disagree with the pack when it comes to the idea that tort reform would do nothing to decrease aggregate costs. While the direct costs of malpractice are relatively small for all but a few areas of medicine, the cost of defensive medicine is very difficult to measure, hence the discrepensies. And though the author states that tort reform would not impact defensive medicine or malpractice premiums for doctors, that lies entirely in the method of implementation. Capping awards will probably not decrease the nuissance suits, only reign in the rare massive awards. Fair panel arbitration could reduce the number of suits and drop them faster, effecting a positive change for doctors. One must only look to differences in state laws and malpractice premiums to see that those claims by the author are faulty at best.

 

[Law2Doc]

sirus_virus, very few people (possibly just the OP) are actually speaking in favor of the lawyers. In fact, you bring up a very good point that lawyers aren't the ultimate cause of the malpractice problem for physicians. Their "expert witness" MD's are since all suits would be considered legally frivolous without their complicity. Moreover, I think you are missing the main point that insurance companies, big pharma, reliance on expensive technology, and government policies would be doing a good enough job to screw up the system without the lawyers involved. They're just making a bad situation worse as a whole. The problem lies in the fact that their cost to the system is borne almost entirely by the doctors whereas the rest are borne by the system as a whole.

However, I have to disagree with the pack when it comes to the idea that tort reform would do nothing to decrease aggregate costs. While the direct costs of malpractice are relatively small for all but a few areas of medicine, the cost of defensive medicine is very difficult to measure, hence the discrepensies. And though the author states that tort reform would not impact defensive medicine or malpractice premiums for doctors, that lies entirely in the method of implementation. Capping awards will probably not decrease the nuissance suits, only reign in the rare massive awards. Fair panel arbitration could reduce the number of suits and drop them faster, effecting a positive change for doctors. One must only look to differences in state laws and malpractice premiums to see that those claims by the author are faulty at best.

Even with tort reform you still will have "defensive medicine". Just because you only have to pay out on legit negligence cases to the tune of a capped amount won't mean you won't still have to show you crossed the t's and dotted the i's on every case. You will still have to defend yourself that you followed the standard of care when sued, so those tests, documentation etc you currently have to do are here to stay even in a capped system, with or without a panel etc. So that's not going to be a healthcare savings no matter how you slice it. (It may lower doctor's premiums but that is simply not a big contributor to healthcare costs, just to physician incomes -- the savings would not be all that much and would not likely get passed down to the consumer anyhow).

As for your expert witness comment I totally agree. Without MD's as experts turning on other MD's you generally cannot even generally bring a medmal suit. So the easy way to cut down this liability would be to better circle the wagons. There is no "code of silence"; Folks are more than happy to turn on fellow professionals for as low as $200/hr.

 

[deuist]

Folks are more than happy to turn on fellow professionals for as low as $200/hr.

One of my professors has even taken out advertisements calling himself a witness for hire.

 

[Law2Doc]

One of my professors has even taken out advertisements calling himself a witness for hire.

You should see the pages full of classified ads placed by docs in the monthly law publications I still get.

 

[maestro1625]

(It may lower doctor's premiums but that is simply not a big contributor to healthcare costs, just to physician incomes -- the savings would not be all that much and would not likely get passed down to the consumer anyhow).

this is slightly off from the "big picture mess" that people are arguing about, but this can become a more significant problem in terms of regional shortage, especially when combined with less "economically advantageous" areas. Doctors have the ability to move, and will. If Wyoming has nasty high premiums and Montana does not, the WWAMI types of the world have an easy choice.

 

[JacobSilge]

this is slightly off from the "big picture mess" that people are arguing about, but this can become a more significant problem in terms of regional shortage, especially when combined with less "economically advantageous" areas. Doctors have the ability to move, and will. If Wyoming has nasty high premiums and Montana does not, the WWAMI types of the world have an easy choice.

Heck, you don't even need to be in such an underserved area to see that. I live about an hour out of a major metropolitan area and many women in my area have trouble finding an OB since so many OB/GYN trained doctors opt to do GYN only, though I'm sure the problem is magnified in more underserved areas.

 

[JacobSilge]

Even with tort reform you still will have "defensive medicine". Just because you only have to pay out on legit negligence cases to the tune of a capped amount won't mean you won't still have to show you crossed the t's and dotted the i's on every case. You will still have to defend yourself that you followed the standard of care when sued, so those tests, documentation etc you currently have to do are here to stay even in a capped system, with or without a panel etc. So that's not going to be a healthcare savings no matter how you slice it.

I guess you might be right, especially since we live in times where defensive medicine is the way things are done. However, I do believe that one of the major factors increasing the cost of health care is over reliance on expensive tests like CT and MRI and a corresponding decrease in the use of clinical judgement from the physical exam. I don't know, perhaps it is naive of me to think that there would be a way to prevent people in the ER presenting with what is almost certainly gas pains from getting an abdominal CT.

There is no "code of silence"; Folks are more than happy to turn on fellow professionals for as low as $200/hr.

Wow, I really thought that they'd have to be paid more than that to sell out.

 

[Yehosh]

$200 for any testimony? now thats prostitution

 

[colbgw02]

I guess you might be right, especially since we live in times where defensive medicine is the way things are done. However, I do believe that one of the major factors increasing the cost of health care is over reliance on expensive tests like CT and MRI and a corresponding decrease in the use of clinical judgement from the physical exam. I don't know, perhaps it is naive of me to think that there would be a way to prevent people in the ER presenting with what is almost certainly gas pains from getting an abdominal CT.



Wow, I really thought that they'd have to be paid more than that to sell out.

I tend to agree with you, but this also highlights other issues of our system. Chiefly, the type of medicine we practice, in general, is very expensive. Running expensive tests and giving expensive drugs is now considered standard of care (or at least common care). Transplant medicine, full-course chemo for recurrent stage IV cancer, dialysis for 85 year olds, 6 month NICU stays for 23 week gestation babies - these are all parts of our healthcare system that heavily favor the needs of the individual over those of society. I'm of the belief that the public won't allow us to change that (which is why people who advocate for socialized healthcare don't always know what they're asking for, but I digress). Part of that is liability. But it's also an issue of expectation in what is very much a customer service industry.

 

[Law2Doc]

$200 for any testimony? now thats prostitution

That's $200/hr. If they have to review the file and testify it would be a lot more than an hour.

 

[Law2Doc]

I guess you might be right, especially since we live in times where defensive medicine is the way things are done. However, I do believe that one of the major factors increasing the cost of health care is over reliance on expensive tests like CT and MRI and a corresponding decrease in the use of clinical judgement from the physical exam. I don't know, perhaps it is naive of me to think that there would be a way to prevent people in the ER presenting with what is almost certainly gas pains from getting an abdominal CT.

These tools/tests will still be relied on because no matter how doctor-friendly you make the laws, you are still going to hold doctors liable for negligent activity. The laws will not change to deny negligently injured patients their due. So people will always use do what they can to protect themselves even if you capped the awards, limited the frivolous cases etc., because they still have to show they weren't negligent, even if they aren't at risk for frivolous things or ulimited awards. Look at other businesses/professions besides medicine and you will see a ton of CYA activities, documentation, etc because it's the way you prove you weren't negligent if you ever have to. So no, a lot of this defensive activity is not going to change with tort reform. Which is why the savings you can get by cleaning up medmal are pretty nominal (except to the individual doctors that were sued).