The High Cost of Practicing Medicine in the Northeast?
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There was a fascinating article in Tuesday’s BOSTON GLOBE, entitled “Doctors’ Fear of Lawsuits Tied to Added Costs of $1.4 Billion.” The central thesis was that Massachusetts physicians are so afraid of being sued for medical malpractice that they are practicing “defensive medicine,” that is, ordering extra procedures and tests, and racking up the attendant extra costs, in an effort to prove how careful they are when treating patients. The physicians hope that adopting this practice will insulate them from medical malpractice suits.
Between this cost, and the burden of greatly increased malpractice insurance premiums, physicians clearly have a legitimate cause for concern about their financial livelihoods. But the organization that represents their interests in Massachusetts, the Massachusetts Medical Society, wants to solve the problem by capping monetary awards to injured patients. That, it seems to me, is simply dumping the problem on the people who can least afford any further problems–the victims of medical malpractice.
In its study, as reported on by the BOSTON GLOBE, it apparently failed to look in any other direction for solutions to the problem. That’s too bad, because studies in our state (NY) repeatedly show that the bulk of medical errors are committed by the same incompetent physicians. In a sense, a select few “bad apples” are ruining it for the majority of physicians, who are perfectly competent. So, the Medical Society might want to take a look at itself, at its membership, and offer programs to re-train, or increase training in particular areas. It might want to make substance abuse programs more readily available to its members. In other words, it might look to the source of the medical malpractice, instead of penalizing its victims.
There was also no mention of the role the medical liability insurers may play in the skyrocketing rates that physicians across the country are paying. Modern consumers of medical care, and the doctors who provide it, are too sophisticated to believe that the high rates are solely the result of “the medical malpractice crisis.” Insurance companies, like many other corporations in the U.S., have made plenty of poorly thought out investments with the huge sums of money they have collected from doctors and hospitals over the years, but they can’t acknowledge that on the public stage. It is much more convenient to blame the victims of medical malpractice.
In New York, Eric Dinallo’s Medical Malpractice Liability Insurance Task Force has gone nowhere and done nothing, though it was created to address the costs of medical malpractice. Recent news watchers predict that Dinallo has one foot out the door, as he may be the next SEC Chairman. And so the problem remains just that–a problem.
When our state begins to take a serious look into the costs of medical malpractice, perhaps instead of discussing “tort reform,” it can investigate “insurance reform” and “medical reform.” American patients would be much better off for it.
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throckmorton said:
I agree that caps are not the answer. There is malpractice and patients need to be compensated. The problem is that medicine is now being practiced according to a “legal standard of care”. A patient presenting to the ER with a headache is a classic example. The patient has a classic migraine history and findings. If we use an “evidence based approach” we know that there is a 99.9% probability that this is indeed a migraine and we can treat appropriately. The “legal standard of care” is that there is a 0.01% chance that this patient may have another inracranial problem that is unrelated to this but can result in a lawsuit. So, instead of using the “evidence based standard” the ER doc will order a CT of the head. This adds additional cost to the patient and thus on to society in general, raising healthcare costs and diverting resources from areas where it is needed more. Unfortunately, “evidence based standards” do not hold up in court or in pretrial settlements. This is partially due to “expert witnesses” who will always say that an additional test should have been ordered.
If we have a concerted effort to define what is the true “standard of care” and define this by “evidence based medicine” healthcare providers can order the appropriate tests as defined by the research as opposed to ordering the multitude of tests that are done for CYA.
These evidence based guidelines already exist but to use them it is essential to define to what degree they need to be both sensitive and specific. Are tests and diagnosis that are 99% correct good enough? This means that 1% will still be misdiagnosed. At present 99% is not good enough because this means you can still be sued. So where do we set the bar?
Here is another classic example. Mammograms are notoriously difficult to interpet, they do not have a good sensitivity or specificity. As a result, radiologists are routinely sued for missed diagnosis because the sensitivity goes up in hindsight with expert witesses who already know the diagnosis. Right now our radiologists recommend serial mamograms and then MRI and ultrasounds of the breasts routinely. How do we protect the radiologists and at the same time encourage them not to order unnecessary tests?
So, what is the solution? I do not think that “witnesses for hire” are the answer, nor do I think that we need healthcourts. I do think that we need defined standards of care and have then based on true statistical evidence. We cant survive the “legal standard of 100% sensitive and 100% specific. These diagnostic care and treatment alogrithms can then be used as the guidelines of what is appropriate. When there is a deviation of guidelines, the Boards of the medical specialties should then be the “experts” to testify as to whether or not there has been a “true malpractice” event.
November 21st, 2008 at 8:10 pm