Sunday, August 11, 2013

What a Survey of 1,400 Sued Doctors Can Tell Us About Health Care Reform

The Razor: Ever wonder how malpractice lawsuits turn out and what their effects on physicians are? Then click here for a slideshow showing the results of a study of 1,400 physicians who were sued for malpractice. There are several interesting points to take from this survey, including the fact that the majority of plaintiffs, 57%, received no monetary reward. But the one thing that stands out by far should be the advice these doctors give on slide 22:

  • Follow up even when you think you don’t have to.
  • Practice more defensive medicine.
  • Document more often, more thoroughly.
  • Get rid of rude, demanding, noncompliant patients.

Anyone who expects doctors, particularly primary care physicians (who also happen to be the most likely to be sued) to take on the responsibility of lowering health care costs by ordering fewer unnecessary tests and procedures (I’m looking at you Professor Mead) are simply delusional. Doctors do not have any incentive to stop ordering these procedures, quite the opposite. Whenever they rule out a particular test they must consider a bullet-proof and infallible reason why the test is not required in case they have to testify on the Stand to support their decision. In medicine, as in life, there are few situations that can attain such a level of infallibility. A runny nose can indicate a cold or allergy in a hundred thousand cases but it can also can result from a leak of cerebral-spinal fluid into the nasal cavity in rare instances. Should a doctor order the highly invasive – and expensive – test to rule out this leak in the snot-faced six year old kid sniffling in front of her? This is an extreme example of course, but the point stands: why should doctors risk being sued, a type of punishment judging by the emotional toll the survey shows, for trying to contain costs?

It would seem to me that if you want to reduce unnecessary testing you would address the reasons why they are ordered in the first place, yet this has not been done. While some states have attempted to limit the maximum amount a plaintiff can be awarded from a successful malpractice suit, none have made laws to make it harder to file them in the first place. The cynic may see the hand of self-interest here, with the lawyers who write the laws the ones also profiting from malpractice lawsuits. After all, scientifically dubious malpractice lawsuits almost elevated former Sen. John Edwards to the White House. But to ask doctors to refrain from ordering unnecessary tests and procedures without legal reform is like asking them to commit professional suicide.

The last item is particularly interesting. Legally doctors in private practice do not have to treat everyone who comes through the door. They can turn down patients for any reason. Once they establish a relationship with a patient they can also terminate that care at any time as long as they do not abandon them, usually by offering to care for them for a period of time when they can establish care with another provider. Many medical system reformers have talked zealously about basing payments to doctors on the success based measures, for example, on how well their diabetes patients’ blood sugar levels are controlled. Every practice has a coterie of diabetes patients who are non-compliant. They come in suffering from associated illnesses and for whatever reason refuse to control their blood sugar levels through exercise and diet, then expect the doctor to fix them. Such outcome based reimbursement schemes will only lead to doctors drafting letters telling these patients to find another provider. But even for doctors who aren’t reimbursed partly based on outcomes, it is in their interest to get rid of these patients who are more likely to complain and perhaps sue them.

Doctors have done a poor job at getting their point across in the health care debate in America. This is partly due to the nature of the profession, which tends to operate in solo or small groups and not think in broader terms the way other professions such as teachers and lawyers have done. It is also due to the corruption of the American Medical Association through years of operation in Washington DC reaching it’s pinnacle in the organization’s support of Obamacare in 2010 against the best interests of its own membership (but in line with the leftist ideology of the organization’s staff). But doctors had better learn quickly because if they don’t their profession will become extinct, and the healthcare of Americans will be even worse than it is today… much worse!

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