The uninsured..........

[MikeWaters]

Originally Posted by ERCougar

I see what you're saying, but here we're talking about a cost to the patient/society versus a cost to me. Unless you're advocating we just admit every patient to the hospital, in order to never miss a serious event. But even that's not 100%, as you need to then follow up with some sort of stress test--yup, more radiation and possibly more nephrotoxic dye--I don't think that's really beneficial to the patient either. Ideally, yes, we should always come down on the side of the patient, but then ultimately, we'd all be working for free, right (or at least a minimal subsistence to survive on)? The other problem is that those who are trying to "do the right thing" are getting forced out of practice (witness OBs in PA, ER docs in FL, neurosurgeons/orthos refusing to take call for liability reasons, etc.).

I think an expert panel would alleviate a lot of the issues. Europe has it, Canada has it, we don't. Why not?

That's why there are practice guidelines. Experts look at the research and come up with practice recommendations. You document your reasoning in your note, pointing out why you believe that your decision was in the best interest of the patient.

Psychiatrists have to make life-and-death decisions all the time in hospitalizing or not hospitalizing suicidal patients. It's impossible to make correct decisions all the time, the best they can is make an informed decision and document why they believe the decision they made was the best for the patient.

[ERCougar]

Originally Posted by MikeWaters

That's why there are practice guidelines. Experts look at the research and come up with practice recommendations. You document your reasoning in your note, pointing out why you believe that your decision was in the best interest of the patient.

Psychiatrists have to make life-and-death decisions all the time in hospitalizing or not hospitalizing suicidal patients. It's impossible to make correct decisions all the time, the best they can is make an informed decision and document why they believe the decision they made was the best for the patient.

Exactly. But you're speaking from the best malpractice environment in the country. Admittedly, my state's not too bad either, but I came from a bad state--and it was hell. You just get forced into bad care.

And we both know that following practice guidelines (which don't always exist--as you likely know with suicide risk assessment) doesn't offer complete protection. And that's assuming they both exist and are uniform--rarely the case.

[UtahDan]

Originally Posted by creekster

Can you exapnd on this? It is my sense that verdicts have been rather static, even when controlled for MICRA or other tort reform efforts, but I don't have any evidence I can put my hands on without too much effort.

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.

This is an advocacy piece, but it contains a lot of interesting data. The idea that that premiums are tied to payouts is really just a myth.

https://www.citizen.org/documents/Ma...ysis_final.pdf

[Mormon Red Death]

Originally Posted by creekster

In the words of a most beloved poster here: Link? DO you have nay evidence of just how outrageously large the awards are (IOW, we all assume they are unjustifed; can you prove it)? And do you mena that such awards shouldnt happen ever, or do you mena they are only outrageous if they don't involve the death of a 40 year old father of 4, for example? And do you include awards in states where there are limits on malpractice awards for pain and suffering?

Moreover, the awards are from the juries. People like you (maybe not like you becasue you are, well, unique, but you get the idea) vote for them.

I like how people decry defensive medicine. But I WANT defensive medicine when it comes to treating or examining me or my family. I realize the odds say that I probabyl don't need some of these tests, and a prudent use of resources might not support it, but I don't want to be the loser in that game of chance. I prefer the thought that the doctor will check out possibilities becasue if he guesses incorrectly he might get sued.

I realize the cost of malpractice insurance is a problem, but I am not sure we really want to solve that problem without addressing other issues as well.

If a dr. or a hospital wanted to cut malpractice in half all it would have to do is have their patients sign mandatory arbitration agreements

[creekster]

Originally Posted by Mormon Red Death

If a dr. or a hospital wanted to cut malpractice in half all it would have to do is have their patients sign mandatory arbitration agreements

Which is what Kaiser does and which agreements are enforceable in California.

[Cali Coug]

Originally Posted by creekster

In the words of a most beloved poster here: Link? DO you have nay evidence of just how outrageously large the awards are (IOW, we all assume they are unjustifed; can you prove it)? And do you mena that such awards shouldnt happen ever, or do you mena they are only outrageous if they don't involve the death of a 40 year old father of 4, for example? And do you include awards in states where there are limits on malpractice awards for pain and suffering?

Moreover, the awards are from the juries. People like you (maybe not like you becasue you are, well, unique, but you get the idea) vote for them.

I like how people decry defensive medicine. But I WANT defensive medicine when it comes to treating or examining me or my family. I realize the odds say that I probabyl don't need some of these tests, and a prudent use of resources might not support it, but I don't want to be the loser in that game of chance. I prefer the thought that the doctor will check out possibilities becasue if he guesses incorrectly he might get sued.

I realize the cost of malpractice insurance is a problem, but I am not sure we really want to solve that problem without addressing other issues as well.

I have to agree with you, Creekster. People love to latch onto a handful of "outrageous" lawsuit awards to make their claim that the entire system is broken. Well then, what is the solution? A cap on awards? How is that an answer if the person's damages exceed the cap? Lawsuits make people safer, by and large. It is a check on the system. It can be abused, and oftentimes, the people who are the worst abusers are the attorneys. But their greedy motive still serves a purpose, and a valuable one at that.

People also love to act like the medical industry is being picked on. It may be higher profile because of the size of the awards, but the awards are larger because the damages are as well.

[Cali Coug]

Originally Posted by ERCougar

You THINK you want defensive medicine...

Your 3 yr old falls off the bunk bed. No loss of consciousness, small lump on the head, vomits once, but is now acting fine. You're scared because it's your kid so you bring him into the ER.

In Detroit, your kid gets a head CT. No way your child leaves the ER without one. Doesn't matter what your kid looks like. Doesn't matter what you want. You sign out against medical advice if you don't want one, and your visit will therefore likely not be covered by your insurance.

In Indiana, your child is examined. The doctor decides that the likelihood of your child having a significant head injury is low (say <2%--it's NEVER zero) and gives you instructions for watching him at home and what to watch for.

Now fast forward 30 years. In Detroit, your child develops a deadly thyroid carcinoma. You've totally forgotten about that head CT that likely caused it so you're not suing the doctor--you just write it off as something that happens.

Oh...and I didn't mention the little old lady who feels a little dizzy and is in the waiting room waiting for your kid to get out of the CT scanner so the doc can examine her, send her to discover her cerebral hemorrhage that will kill her. If only the doc could have gotten to her sooner. Oh well...avoided the lawsuit.

Oh yeah...there's also the increase in insurance premiums due to your kid and a thousand others that's going to make the blood pressure medicine unaffordable to the man who will die of a heart attack.

These are all huge issues that we face every day. I assure you I'm not painting the worst case. I've worked in Detroit and that is EXACTLY what happens. I've seen people die in the waiting room because the CT scanner was tied up with bullshit. We've all seen insurance premiums go up. And there are studies coming out every day about the dangers of radiation exposure from medical testing.

Defensive medicine is good for no one. But our hand is forced. After all, tests costs me nothing. Malpractice costs me a lot.

I could think of a hundred similar examples, I assure you. I practice this every day.

That sounds to me like poor administration. If the kid with the minor bump needs a CT scan and you are putting him first in the line ahead of the old lady who is about to die, then I don't think I would blame the lawyers for that lady's death. I would go with the doctor who decided to have the old lady wait and put the kid with the minor bump through first. Even if they all need a CT, that says nothing about the order in which the CT should be administered. And if it happens "all the time," then I would suggest the hospital would save money by investing in a new CT machine. Point being, they will be sued for not treating the old lady fast enough, they will lose, and they will adapt as a result and the process will be better.

[ERCougar]

I'm still waiting for the reason why an expert panel isn't appropriate to evaluate the medical decisions involved in a lawsuit.

No one's saying medical malpractice should be eliminated.

[ERCougar]

Originally Posted by Cali Coug

That sounds to me like poor administration. If the kid with the minor bump needs a CT scan and you are putting him first in the line ahead of the old lady who is about to die, then I don't think I would blame the lawyers for that lady's death. I would go with the doctor who decided to have the old lady wait and put the kid with the minor bump through first. Even if they all need a CT, that says nothing about the order in which the CT should be administered. And if it happens "all the time," then I would suggest the hospital would save money by investing in a new CT machine. Point being, they will be sued for not treating the old lady fast enough, they will lose, and they will adapt as a result and the process will be better.

A new scanner? And thus we have higher medical costs for tests that don't need to be done. Your "solution" perfectly illustrates my point of how attorneys cause higher medical costs.

The reason the old lady isn't going to the scanner first? Because she's in the waiting room waiting for a room to open up so a doctor can evaluate her. Do you know how many weak and dizzy old ladies come through the ER? No, they don't all go to the scanner.

The argument that defensive medicine is somehow good for patients is not a winner for you. Other issues? Perhaps. Please not this one.

[ERCougar]

Originally Posted by Cali Coug

I have to agree with you, Creekster. People love to latch onto a handful of "outrageous" lawsuit awards to make their claim that the entire system is broken. Well then, what is the solution? A cap on awards? How is that an answer if the person's damages exceed the cap? Lawsuits make people safer, by and large. It is a check on the system. It can be abused, and oftentimes, the people who are the worst abusers are the attorneys. But their greedy motive still serves a purpose, and a valuable one at that.

People also love to act like the medical industry is being picked on. It may be higher profile because of the size of the awards, but the awards are larger because the damages are as well.

The answer is to treat medical malpractice like every other specialty law--expert panels.

Attorneys, your collective silence in defending your Bar Association's stance on this is deafening.