04-03-2008, 09:19 PM | #51 |
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And you've therefore fallen for the propaganda of the insurance industry.
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04-03-2008, 09:23 PM | #52 | |
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As to yourt criticism of the insurance lobby, I think you are overstating it, but you do add another wrinkle to the issue showing why both cost fo care and access issues defy easy solution.
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04-03-2008, 09:25 PM | #53 | |
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04-03-2008, 09:34 PM | #54 | |
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In any case, here is the entire article. See for yourself (page 4): http://www.urban.org/UploadedPDF/411...ured_dying.pdf Here is a full copy of the paper referenced. I have not had a chance to read through it yet. http://content.healthaffairs.org/cgi.../full/23/4/223
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04-03-2008, 09:42 PM | #55 |
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Ok, creekster, we're both arguing things we know little about, so let's go after some summary points I hope we can agree on.
1) Defensive medicine is bad. It's bad for the patient involved (Need a non-carcinogenic example, besides the cardiac one? Needless breast biopsies for questionable findings on mammograms.). It's bad for the patients whose care is delayed because of overcrowded ERs. It's bad for society who has to pay for needless tests. The example I gave with the kid falling from the bunk bad isn't real, but it's possible. I HAVE seen people die in the waiting room because of an overcrowded ER. I have seen needless tests contribute to overcrowding. I have seen healthcare costs go up because of more tests. I've personally ordered tests solely to "buff up" a chart if it were to go to court. We're only beginning to understand the risks of excessive medical testing (beyond just carcinogenic risks--needless followup workups from whole-body CT providers for example). Does every head CT on a kid result in a person dying in the waiting room? Obviously not. But the links are there. 2) A responsibility for medical errors is a good thing. There are times when a fear of a lawsuit has kept me on my toes, where compassion or a sense of professional responsibilities has failed because of fatigue or other factors. 3) The layperson is NOT qualified to judge medical errors. It's ridiculous that a high school dropout is going to be asked to evaluate what can be a very complex medical decision. Indiana has an outstanding system where every lawsuit is evaluated by a board of experts before going to trial who give a preliminary decision. The plaintiff can still go to trial if the board decides against them, but at least the jury has access to an expert opinion, not some hired gun. Physicians have sought to expand this to other states and this has been fought vigorously by the Bar association. IMO--a shameful display of greed. 4) Medical malpractice reform will not solve our health care financing issues. Many studies have shown this. However, if health care reform occurs, there will inevitably be some rationing of care, and malpractice reform MUST accompany this for the system to succeed. Final note--I've practiced medicine in four states: Indiana, Michigan, Nevada, and Utah. Two of those are considered high-liability states (MI and NV). I assure you, malpractice liability directly affects practice. To take the example of the kid's head CT. In IN and UT, I would have the guts to discuss the option of sending a kid home after discussing the unknown effects of radiation, signs to watch for at home, etc. No way in MI and NV--you sign out AMA. The problem needs to be fixed so we can do the right thing for the patient. |
04-03-2008, 09:45 PM | #56 | |
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I don't have the numbers on the first point, but it certainly goes counter to my sense. |
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04-03-2008, 09:49 PM | #57 | |
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Any doctor who operates defensively is a bad doctor. A good doctor always acts in a way that is best for the patient. Do you disagree? |
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04-03-2008, 10:04 PM | #58 | |
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Here's the problem...Take chest pain, for example--one of our most common presenting problems. Say I see 100 people with chest pain in a month. Protocols exist to determine who I need to admit and who I need to discharge. The most conservative protocols can get my miss rate down to nearly zero, by just admitting everyone to the hospital and watching them overnight. But then we're defensive medicine and its consequences. So I have to choose an acceptable miss rate--which right now is about 2%. This is what would be "right for the patient" and right for society. The problem is that the plaintiff doesn't care about right for society. The attorney just knows that you missed one and you're gonna pay. If I see 100 people with chest pain in a month, that means I will miss 2 people every month with a serious cardiac issue. In some states, that's OK. In Florida, I'll be forced out of practice because I can't pay malpractice insurance. Now...what's right for the patient? |
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04-03-2008, 10:10 PM | #59 | |
Demiurge
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04-03-2008, 10:32 PM | #60 | |
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I think an expert panel would alleviate a lot of the issues. Europe has it, Canada has it, we don't. Why not? |
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