Grinding to a Halt
Posted by GruntDoc on February 1st, 2006
I’ve been in a foul mood of late at work, and it’s because I see the beginning of the end of the health care system I know and respect.
I am not involved in health care policy, or planning, just the trench-line delivery of modern, ‘high-tech / low touch’ American medicine. I realize it’s terrifically inefficient and at the same time realize I am individually powerless to change it. However, I’ve been thinking more and more about our future, and it’s not at all good.
I’ve recently had several interactions just like this one from Australia:
Sometime during the night they were moved out into a corridor to make room for the incoming. I saw them again the next morning. There was no longer any room to sit beside her, so he stood at the foot of her bed. He was angry. “This is disgraceful” he shouted. “I’ve had top private health cover for as long as I can remember….and now I need it, I can’t even get a bloody bed for my wife!”
He sat, red faced and embarrassed at his outburst. It was all beyond him.
Since November, with few exceptions, we’ve been ‘holding’ admitted patients in the ED. Yesterday we had about 1/3 of our physical rooms occupied with patients ‘admitted to the hospital’ who were going to be cared for in the ED. No windows, no TV, no phone, just a real hospital bed, real hospital food and their medications. It’s the biggest shock to people who haven’t been to an acute care hospital for a while, and just assumed there would be space in the hospital for their loved one. This is, by the way, after we’ve been putting admitted patients in the hallways of the upstairs wards to try to relieve the ED overcrowding.
So, 1/3 of our space is now dedicated to inpatients, therefore the hallways were lined with gurneys of the actual ED patients. Four years ago this was an occasional, ’surge’ thing and now it’s everyday and around the clock there are patients being cared for in the halls. (Mental exercise: describe how much fun it is to give a history in a busy hallway with people and other patients / families constantly walking by, and I’ll leave the thrill of the physical examination to your imagination).
There’s no incentive for hospitals to add beds, unless you happen to have one of those really-well-billing cardiac diagnoses, and there’s money for that, so hospitals are building cardiac units that are closed, meaning if you don’t have a cardiac diagnosis and a cardiologist on the case you lie in the hall. We have, simultaneously, the best and worst healthcare has to offer.
I’m of the opinion many of the problems of modern healthcare do stem from a complete absence of a market in medicine. I wouldn’t take my car to the shop and just say “fix it” without at least discussing the costs (unless I had the insurance / medicare system for my car, then I’d drive it like a nut and sue if it wasn’t perfect when it came out of the shop). I’m 100% for posting signs in the waiting room, patient rooms (and, regrettably hallways) outlining what these tests they’re getting charge. It’d be eye-opening, and it might just cause a few people to think about need vs. want, and would make my job a little harder. I’m okay with that. I’d like to discuss the pros and cons of ‘do you really need me to CT you from stem-to-stern’ with an alert patient who’s able to make informed decisions.
People ask me what I think the future of medicine is when we’re staring at the overcrowding, and ask what I think will happen. I don’t think it’s going to be anything cataclysmic, we’re just going to grind to a halt at this rate. Money continues to be poured down expensive therapies of marginal benefit, there’s no barrier to asking for more healthcare, “now!”, and have a quick peek at nursing demographics if you’re in doubt about the short and long term problems we face.
The Wall Street Journal (may require subscription, sorry) has an editorial about healthcare today, and here’s the money:
[Shifting to a market system] won’t be easy, especially given the ideological stake that so many politicians have in a government-run system. They like the leverage of determining payment rates to hospitals and doctors, not to mention being able to take credit with voters for providing more benefits. But there is no free lunch in health care, any more than there is in any other part of the U.S. economy.
Health care is either going to be allocated by prices or by government, which in the latter case means price controls and waiting lines. Though it represents one-sixth of the U.S. economy, health care is the one industry in which the purchasers actually have no idea what anything costs. An individual market for health insurance would allow more freedom of choice while making consumers more cost conscious.
If we don’t do something, soon, there not only won’t be a medicare system, there won’t be anyone in the hospitals left to take care of us. If we can get out of the hallway, that is.
February 1st, 2006 at 9:25 am
From a pediatrician’s standpoint, the bed crunch problem and the ED problem are the same problem: inappropriate use of medical services by patients and doctors alike.
Pediatric EDs in my community are packed with kids who are not emergently ill (leave aside for the moment the reasons why this is the case).
My recollection of medical services at pediatric hospitals as well as peds floors at community hospitals is that most of the inpatients did not require hospital level of care.
I acknowledge that the situation may be different in the grown-up world.
best,
Flea
February 1st, 2006 at 12:36 pm
What we are talking about is a shift in the business model of health care in this country. This will require so many changes that they will not be accomplished all at once nor will they be accepted.
Welefare folks can now call a squad for a free ride to the hospital instead of paying to go to a regular doctor. Many in the politiacal system see this as a plus and a reason for reelection.
I know one doctor who sends all after hour calls to the ER. The reason is they get paid for the call, if admited they sign the clip board on the door and get paid again, and they eliminate the liability.
Doctor’s get paid to test, so you test. Working with a patient does not bring in fees.
Hospitals are the only money making part of the doctor side of the equation so they encourage 24/7 usage. The list goes on with the result of over crowding, over worked staff, and a very frustrated patient base.
Change is not accepted so the system will only get worse as “experts” tell us how to spend more money on a system that needs a major overhaul, not more money.
February 1st, 2006 at 2:07 pm
Here’s a question that might illuminate the problem a bit – I am asking this earnestly, as I honestly don’t know the answer: if someone were to open a private emergency room, would it be financially viable?
If it would – presumably by offering high-quality care to those who could afford it – then the next question to ask is why we don’t have them now.
If it wouldn’t, then I guess we could assume that people are simply not willing to pay for care that is much better than what they currently recieve.
Personally, I’d love to have the option of private emergency care. I’ve be happy to pay the difference between what my insurance would cover and what I’d be billed, assuming that the quality of the care justifed the additional expense.
February 1st, 2006 at 2:25 pm
“Since November, with few exceptions, we’ve been ‘holding’ admitted patients in the ED. Yesterday we had about 1/3 of our physical rooms occupied with patients ‘admitted to the hospital’ who were going to be cared for in the ED.”
It sounds like UPR Carolina (University Puerto Rico teaching/gov hospital) where I had the displeasure to see my mother stay, in ICU, for 6 weeks until she passed (she became ill in the PR airport on our way home from a holiday in the Caribbean). Point is, it was dirty (you have no idea). Top paid nurses work in ICU and make $9.50 an hour and have basic training. They work in ICU to get better experience and hope to move to a private hospital (like Auxilio Muto or Pavia) and get another 2 bucks per hour. I certainly hope we are not headed that way with nursing/physician shortage…sigh…
Cynde
February 1st, 2006 at 5:57 pm
One problem I see with market-driven medicine is that patients have to be willing to take responsibility for their decisions. Let’s say I see a patient that has been put on (cheap) amoxicillin three times in a row for the same persistent sinusitis, by a “quick care” doc, and I(as the Ear Nose and Throat specialist)recommend a stronger (and more expensive) antibiotic, and the patient balks at this. I then get called in the middle of the night from the ER when the patient comes in with proptosis due to an intraorbital complication. Now, am I obligated to treat this horrendous complication in the middle of the night, with a patient that may SUE me for presumably not adequately treating her infection? Am I obligated to take this non-compliant patient to surgery, especially since her high-deductible MSA plan means I won’t be getting paid a dime for my troubles (if she didn’t want to spend money on a good antibiotic, she won’t be spending it paying my bill after the fact)?
I don’t want to couch this argument in terms of money, but that is exactly what will happen if market-driven medicine occurs. You can’t have the consumer(patient) playing by one set of rules, and the doctor having to play by another–the doctor always has to do what’s right, even if it costs him. In this game, the doctor will always lose. In this scenario, if I refused to come in to treat this non-compliant patient, not only would I be infintely sue-able, but I would potentially be hauled before the medical board to answer charges of patient abandonment.
The liablity issue has to be addressed adequately before any such conversion to a market-driven health care system takes place. Additionally, if patients choose not to follow the physician’s recommendations solely based on cost issues, then a physician should be able to consider that patient discharged from his or her care at the point of that non-compliance.
February 1st, 2006 at 7:45 pm
We all seem to talk about the market driven fee-for-service no-middle-man medicine as though the problems inherent in this kind of medicine are new and unprecedented. But this was the medicine practiced in this country up until the second half of the twentieth century. Sure, a lot of the pharmacological and technological advances came after but the problem of treating people who are unable or unwilling to pay for their medical care is not new. This theme can be found in William Carlos Williams’ literary work. In fact, I would venture to say that this problem is almost as old as medicine itself. Physicians were able to deal with it then and I do believe they would be able to deal with it now.
February 1st, 2006 at 10:36 pm
Excellent post. Our units have been full to the gills, with our overflow units open more often than not. We’re constantly triaging patients out of the unit to accomodate the ones trying to get in from the ER. Today we hit our limit, and I’m not sure what they did with those ER patients, but they certainly did not come to ICU.
Not ours, anyway.
February 1st, 2006 at 11:30 pm
Gosh, GD, you sound like a libertarian! (I’m with you on the posting prices thing, but the problem is the prices are artificially high, b/c collection rates are so low. And at my ER, the taxpayers pick up the tab for everyone anyway.)
Mike: Regarding private ERs, I think what you mean is pay-for-service, as most hospitals are private and for-profit. There are pay-for-service urgent care clinics, at least one I know of in Santa Fe. They can actually charge less because of lower overhead and 100% collection (you have to have cash or credit!). But there are no pay-for-service emergency departments–EMTALA (unfunded mandate) makes us take care of all comers.
February 2nd, 2006 at 12:22 am
My Hospital’s ER has been “full to the gills” for about 2 years now. It creates another problem, in my mind: Every time I walk into work, the ER is in major crisis. I feel like an abused spouse: I drive to the hospital knowing the place will be an out-of-control crisis, I know it will be painful, I just don’t know where the abuse will come from today. The job is starting to affect my health. I walked in one night and there were 75 patients either boarding, being seen, or waiting (In a single coverage ER). Part of it is that any one of these patients may be my next lawsuit, but in reality, it’s more than that. How can I care for 75 patients at once, by myself? I don’t know what the solution is, but the system always seems one patient away from totally collapsing. I just pray I make it to retirement without a lawyer stealing my life savings due to a bad outcome.
February 2nd, 2006 at 12:25 am
bad shift,
There is such a thing as stand alone ER’s. Emtala aplies to hospitals that accept medicaid/medicare dollars, but does not apply to Urgent Cares, or to a “stand alone ER”, AMA news just had a feature article about them. Florida, I believe is where they started. Myself and others have been tossing around the idea for a while. I have mixed feelings about it. The idea of being able to provide faster, better care they way I want to and not be subject to a hospital administration, and potentially make a lot more mony is intrigueing. But I have mixed feelings as I think most ER doctors wear a badge of honor in taking all comers, regardless of race, economic status, or blood alcohol level. After all if we were to get a patient that needed ICU or surgery they would have to be sent to some poor schmuck working in a hospital that is already overloaded further “breaking” the system that gruntdoc is talking about
February 2nd, 2006 at 9:41 am
Earning Cranky Points
Warning: for health professionals only. Certain things tends to make doctors cranky. Such as being alledgedly allergic to all opiates except intravenous Demerol. Sure, it could be true. But not nearly as often as claimed. Wondering how to earn Cranky
February 2nd, 2006 at 10:26 am
This happens every year… respiratory season hits and ERs (and ultimately the patients) are left holding the bag, either due to a lack of beds, or a lack of nurses to support those beds. When we hold patients, we run out of rooms, and sick people are left sitting in the lobby. It’s only a matter of time before somebody codes out there and the relatives drag everybody into court over it.
This isn’t a surprise… every year we see these disasters coming, and nothing is ever done to address the problem in advance.
In many ways, medicine is a very poor business, and highly-regulated to boot. People feel entitled to your services simply because they exist, and have no problem stiffing everyone else with the bill. I have patients (some of whom I recognize) who give a different SS# to our registration folks every time they come in, just so they won’t get a bill. These people don’t come to the ER for real emergencies either… they use us as a primary care clinic. They KNOW we have to see them, and all our surrounding walk-in clinics require cash/CC/Insurance just to get in the door. Sending all the non-payers to the ER is the best thing going.
Once the next round of medicare cuts and pay-for-performance initiatives goes into place, I predict medicare will become the new medicaid. Nobody will accept it, PMDs will fire their non-compliant patients, and they’ll all end up being funneled to the Emergency Room, further exacerbating the problem.
I enjoy taking care of people; it’s the whole reason why I chose this profession… but between the regulatory burden, overcrowding, payor issues, plaintiff’s attorneys… medicine in general (and EM in particular) gets into deeper and deeper trouble every year.
My opinion? It’ll take a true collapse of this house of cards before anyone takes it seriously.
February 2nd, 2006 at 10:33 am
Those of you thinking about a market solution are just dreamers. When a Republican President can pass a boondoggle of an entitlment program like the Prescription Drug Benefit, and the only complaint made by the other side is that it’s not enough, then getting the government back out is an impossibility.
We have the perfect storm of policital opportunity about to hit. Democrats are already on board for universal health care, and big business, the Republican constituency, is screaming for relief from its pension (primarily healthcare) obligations.
The VA is the model, and pretty soon we’ll all be using it.
February 2nd, 2006 at 11:23 am
I work in a hospital that has about 900 beds and sees about 50,000 ED visits per year. On a daily basis we keep about 6-8 of our 25 beds full of admitted patients. Almost always there are three to four psych paitents holding for a room. We have several psych hospitals in town, they are always full. Most of the time we are holding one or two ICU patients in the ED. There is undue strain on the ED in terms of staffing, patient safety and patient satisfaction. The hospital grades us on patient satisfaction, the plantiff laywers grade us on patient safety and the turnover of nurses and lack of new recruits speaks volumes for the working environment. I think a great deal of education is in order. First we need to educate the PCP’s not to refer every patient that calls their office to go immediately to the ED. On an average day about one in 5 or 6 of my patients will have been referred to the ED by another MD, or will have seen another MD for the same compaint and just want “another opinion”. The patients need education on the cost of healthcare. I frequently see patients that won’t go their MD because they owe them money. I am quite sure that they are not going to pay us either. Also the hospital needs to understand that overcrowding in the ED is not and ED problem, it is a reflection on the failure of the entire hospital system to perform. I am not sure what the answer is, except to try and educate everyone along the way and hope someone pays attention. It is always easy for everyone to blame the ED for being overcrowded, slow, having no privacy, being inefficient…….
February 2nd, 2006 at 2:41 pm
I work in a 40 bed ED with about 200 inpt beds and almost 70,000 annual census. The top administrator on call closed the hospital a month ago one Sunday afternoon for several hours because the inpt beds were full. There were very few anticipated discharges. There were 35 or so admitted pts taking up the ED beds and hall beds, and a waiting room full of ED patients yet to be seen, in a ED that on an average winter day admits probably a quarter of the daily census. It was ugly.
February 2nd, 2006 at 6:50 pm
Yikes.
Am I headed into the wrong profession?
-J
February 2nd, 2006 at 7:07 pm
Paul Starr. The Social Transfomation of American Medicine. Basic Books, 1982.
Read this book. Everyone who reads this, read this book. Starr predicted this crisis of access twenty four years ago and offered solutions. No one has surpassed his work in 24 (24!) years because his analysis is still absolutely thorough and correct.
February 2nd, 2006 at 7:09 pm
I concur with a lot of the arguments made here, and I agree that a dose of market discipline would probably help — but only up to a point.
I don’t know what the answer is, but one thing seems reasonably clear: if health care were left entirely to the private market, there’d be a lot of sick patients out there who wouldn’t get any medical care because they couldn’t afford to pay for it. And we wouldn’t tolerate that. We’d do what we had to do to get the government back in the business of subsidizing health care for the poor, the sick, and the elderly. Eliminating government subsidies will not happen — we’re not that barbaric. The question, then is how to manage the subsidies intelligently and humanely.
And that’s a tough, tough thing to do. “The market” isn’t a silver bullet, any more than “universal coverage” is a silver bullet. I think one of the biggest obstacles to changing anything in health care is fear — fear that we’ll be worse off under a new system than we are now. So most of us hate the status quo, but we fear what would happen if we tried to change anything.
I agree with TheNewGuy: this house of cards will have to collapse before anything will change. The good news? It will collapse sooner or later. I’m betting on sooner.
February 2nd, 2006 at 10:23 pm
Jeremy
If you havn’t entered medical school yet. DON’T DON’T DON’T, A THOUSAND TIMES DON’T.
February 2nd, 2006 at 11:43 pm
Jerry thanks for the info of pay-for-service ER’s, I didn’t know that. Seems like decompression at any level would be a good idea over all (though like you said, if those patients are ill and require admission then they overload an already taxed system).
Oh, come on Kevin, I know at least 2 doctors who enjoy their work–maybe Jeremy’ll be one of those. (And if not, maybe he can be one of the many others like myself who spend a lot of time hiking and backpacking!)
February 3rd, 2006 at 1:13 am
Wow, thanks for the comments, please keep them coming.
For the record, I don’t think ‘the market’ is a synonym for soup lines and lack of medical access for the poor (Charity hospitals used to exist, and will continue to). And, while I think it’s a terrific ideal for a society to ban together to make sure there’s a safety net, those in the net have an OBLIGATION to realize they’re spending the hard-earned money of others (the Government doesn’t make money, it spends yours) and therefore it’s for emergencies and true needs, not wants.
I’m extremely pessimistic about rationing that’s not monetary. HMO’s (and yes, I realize they aren’t perfect, nor is any system) tried to impose external constraints on expenditures, to the utter vilification of the entire industry. And I worked in the military system, which is as close to socialized medicine as I ever want to get. The care was fine, but the access was limited, and there was a ‘one size fits all’ to it, not to mention the entitlement mentality that came with it.
The UK is having fits with their socialized system, as are the Canadians: big chunks of the budget with big management and poor accountability. The devils we know are high costs and relatively rapid access (if you have money / insurance), and huge annual increases in expenditures without commensurate increases in effectiveness.
In the US given BOTH political parties’ track records with fiscal restraint it’ll be a race to complete bankruptcy of the nation. “We’ll pay for that!” will be the cry of both the pander-parties. Another devil we know.
Does that mean there’s no place for a government safety net? No, that’ll always have a place. And, money will always talk, so there’s a place for private insurance. The trick is to have enough people pay DIRECTLY for their insurance so it’s not abused, and for the insurance companies to stop poaching on big companies and have to market to individual consumers. (Insurance also shouldn’t, IMHO, pay for stuff like routine physicals, etc, it should be for acutal illness (and I expect an argument about that)). And we should demand that the government money spent on healthcare isn’t siphoned off either by crooks or paper-pushers. (Our family doesn’t give to charities that have more than 10% overhead, why should Medicare?)
And, I ordered the book, free-standing ED’s exist (they aren’t called that but they’re there) and they just treat the symptoms of the problem. Jeremy: Yes, and good luck. You’re in good company.
February 3rd, 2006 at 7:03 am
heh…um…Kevin…
I match in March of 2007. Too late to turn back now.
February 3rd, 2006 at 1:28 pm
Jeremy,
OK, don’t put a bullet to your head. We need energetic young docs to tackle the challenges we face. I enjoy EM. It is more interesting than being being a plumber, patholgist, or physical therapist. I just wonder if it can be maintained for a lengthy career. All the things discussed above have made a noticeable difference in the last 10 years in how hard daily practice is. Factor in the swimming sharks waiting for you to misstep in an impossible work environment that is booby trapped starts to wear down the most energetic, idealistic among us. EM, as the “safety net,” is the canary in the coal mine for the whole system.
February 3rd, 2006 at 1:37 pm
And the winner is…
Erica, who submitted GruntDoc in the first iteration of Battle of the Books. This is thoughtful, well-written blog by a Texas emergency physician that I will return to. The most recent entry is a pretty depressing view of emergency rooms…
February 3rd, 2006 at 2:45 pm
Well Said!
I see the same issues:
GruntDoc
Kevin, M.D.
Yesterday we were "housing" 12 inpatients (most ICU/telemetry) in our 16 bed ER with an annual census now peaking at 40K (up from 25K, fifteen years ago).
February 3rd, 2006 at 5:56 pm
To Jeremy: I’m an ER doc. I went out to dinner last night with several of my med school buddies. I’m the only ER Doc, I’m the only one in a specialty being raped by lawyers. While they were gloating about their future, their next job, the advances in Neurology, GI, etc. I kept talking about how I just want to retire. I’ve been physically and verbally assaulted by patients, had my nose broken, been spit on, and about once a year I’m threatened with a lawsuit. I’ve had to take HIV meds several times after bad needlesticks. Don’t be a martyr. It wears on you after a while.
February 3rd, 2006 at 7:50 pm
As a patient there are some things you guys say that seem very troubling. I worked for over 30 years and always had good ins. through my place of employment. It was part of my benefit package just like many other folks health plans. My contribution to this plan was very cheap (about 30.00 per month). Being employed full time I could have certainly afforded to pay more for the plan we received.
Flip ahead until now! I’am disabled and no longer work. I receive social security disability benefits based on the number of work credits I had earned during my lengthy employment. When you qualify for SS disability ins. payments, you have to wait for 2 years before you can begin to receive medicare. I applied for medicaid during this period, waiting for medicare to go into effect. I was approved, but I have what is called a spend down that must be paid each month, before I can receive my card for coverage for that month. That spend down is more than $300.00 each month. Now for $300.00 per month verses $30.00 per month, I have lost my PCP, who I had for 15 years, because his office does not accept medicaid. I have been looked at and spoken to by health care professionals who must believe that since I’am using medicaid I must be some lazy lowlife who hasn’t worked a day in my life. I have to go to a medicaid clinic to receive my check-ups and prescriptions.
I think many of you have misconceptions and preconceived ideas of what you believe about certain people, based solely on the type of coverage they have. You could try and convince me that this is probably a figment of my imagination, or, that I might be sensitive over the circumstances, and therefore read things into peoples behavior that may or may not be there. That is absolutely not true. Remember, I had good coverage for more than 30 years. I have experienced this difference in the medical professionals behavior first hand. The worst is going from being treated like an intelligent human being when I would go to the Dr., to all of a sudden it being assumed that I’m an illiterate person, who couldn’t possibly understand my own medical conditions.
So yes, the healthcare certainly needs fixing but so does many of your attitudes.
February 3rd, 2006 at 8:19 pm
To the last poster Anonymous.
My sympathy for your condition. And no, you should not be spoken down to based on your insurance coverage or for any other reason; that isn’t right. I suggest you find doctors who you think treat you properly.
That being said, I think you will not necessarily find it very easy to have a broad choice of doctors in many places when your only coverage is Medicaid. Your former doctor’s practice probably found the way they were treated by Medicaid agencies, and now more commonly their low-dollar managed care contractors, was unacceptable. Medicaid rates rarely cover overhead, never mind paying for the doctor’s time, and that is when they pay at all. Going to a practice with your Medicaid card is basically telling them you expect care without properly paying your way.
On those terms, it is remarkable that any doctors at all will accept Medicaid. If you think you are entitled to service on those terms, then I am not surprised your visit is not met with enthusiasm. That kind of entitlement attitude is very common among Medicaid beneficiaries, unfortunately, and for a provider who sees himself as giving away services without pay, it can be grating after awhile. Many doctors would rather not deal with that kind of negative repetetive experience, and so avoid all Medicaid patients. As a doctor who has and continues to see Medicaid patients, I can see their point. If it became onerous to me, I would do the same.
February 3rd, 2006 at 8:20 pm
anon 7:50
I browsed through the posts. I really don’t see anything about judgements made about the character of people on medicaid. I think you are reading something into it. Doctors who accept medicaid do it precisely because they DO CARE about the patient. In many situations it actually COSTS the doctor to take medicaid insurance. If medicaid reimburses me 30 dollars for a visit, but the cost of supplies needed, billing, insurance, staff costs, electricity, etc costs 50$ then I took a 20$ out of my business to see the patient. Other businesses can’t operate like that, neither can medicine. That is why the system is broke.
February 3rd, 2006 at 9:57 pm
Well, I certainly see both of your points about medicaid. My point is, when I was paying 30.00 per month, out of pocket, I received wonderful medical care. Now that I’m paying hundreds of dollars per month (for a plan that you say doesn’t cover much) I receive second rate care at best. I haven’t changed, as a person, since the days prior to becoming ill, and I’m paying more out of pocket, on a limited income, than before and the difference in treatment is quite noticeable. I have never in my life treated any physician with anything other than respect, I expect to be treated the same way.
I worked all my life and paid into these programs (the same as you do) so why the attitude when a situation arises that forces us to use these programs for the very reasons they were developed in the first place?
Medicaid could save millions of dollars if they stopped rewarding single parenthood with more money and increased benefits with every birth.
February 3rd, 2006 at 10:43 pm
“My point is, when I was paying 30.00 per month, out of pocket, I received wonderful medical care. Now that I’m paying hundreds of dollars per month (for a plan that you say doesn’t cover much) I receive second rate care at best”
You are forgetting something, here. Your employer paid most of your insurance premiums. Consider yourself lucky to have only had to contribute $30 a month for so long. It sounds as if you had great employment benefits. And on your behalf, I am sure your insurer then treated the charges of your doctors much more fairly than does your Medicaid managed care plan now. From your post, the spenddown requirement of Medicaid requires a monthly deductible before you are covered by them. Annually, that seems to be a total of $3600, by your figures, after which you become eligible for Medicaid coverage. Compared to what you paid out of pocket, that must seem like a lot. I am sorry you seem to confuse what you are paying out of pocket with what was actually paid on your behalf when you had better insurance and lower contributions. Now you think you are paying more–and you are as far as out-of-pocket expenses go–but you almost certainly aren’t as far as what you and your insurer together are paying for your services. As I and others have posted above, Medicaid patients typically don’t pull their weight as far as fairly covering their costs go. You may attribute reluctance to provide you service you are used to as unfair, but when you aren’t offering adequate payment, you are fortunate to have anyone to see you at all. A doctor doesn’t owe you his time today at a discount below cost just because years ago you had better insurance that paid some other doctor better. Medical practice isn’t a collective, and you don’t accrue an entitlement to someone else’s service just because you paid taxes, or insurance premiums years ago when you were working.
It is probably moot, but did you ever consider the value of private disability insurance during that time when your contributions to your medical insurance premiums were so low?
February 3rd, 2006 at 10:45 pm
I see it from your perspective, but when you had “good insurance” and were paying 30$ per month your employer was probably paying a bundle and you benefited from all the other people in your plan that were not utilizing health care. The health care dollars don’t just magically appear.
February 3rd, 2006 at 11:56 pm
Your both right and I’m not disputing that, nor do I think my 300.00 per month “spend down” is too much for me to be expected to pay. We just aren’t talking about some of the same issues.
As for the question pertaining to if I had thought about disability insurance while I was paying all those low premiums, the answer is “of course I did”. I not only had provided to me by my employer short term disability that would have lasted 6 months, I also made sure I had a safety net by extending my short term disability for 3 years. A plan that I paid the full monthly premiums for.
What you don’t know, is that within weeks of trying to return to work after major cancer surgery, and getting ready for radiation treatments, I came home one day (we all did) and found a letter in the mail telling us that our boss was cancelling our entire group policy for our health ins., it was effective exactly 3 days after we received the notice. Since he cancelled the entire policy, none of us were eligible for COBRA. Try having cancer and purchase private health ins. IT WON’T HAPPEN. But, there was HIPAA, that states that since I was in a group policy and that policy was cancelled through no fault of mine, I had to be offered a plan. Trust me, you don’t want to know what that plan would have cost. It was not doable.
I was still trying to continue working at that time so my long term disability didn’t help at all. By the time I left the work force, I had cancelled my long term disability, because I couldn’t keep up the payments with all the medical bills that were way out of control.
I’am thankful for what I’m receiving. I just think before anyone passes judgement on someone else and treats them in a manner in which they believe they should be treated, they should ask some questions and become knowledgeable about individual situations.
Of course, we will never see eye to eye on this, our perspective is completely opposit. You are both looking at it “objectively” while I’am completely “subjective” to this issue. That makes a world of difference.
February 4th, 2006 at 12:16 pm
Jeremy,
Think of it this way. You’ll never have to worry about having enough money to put food on the table, about paying your utilities, your mortgage, about your kids not being able to afford to go to college. And, with even a little bit of financial planning, you’ll not have to worry about being broke in retirement and living off charity.
Keep some perspective if you can. No matter how bad you think you may have it, there are many others who are much, much worse off.
February 4th, 2006 at 12:53 pm
“Jeremy,
Think of it this way. You’ll never have to worry about having enough money to put food on the table, about paying your utilities, your mortgage, about your kids not being able to afford to go to college. And, with even a little bit of financial planning, you’ll not have to worry about being broke in retirement and living off charity.
Keep some perspective if you can. No matter how bad you think you may have it, there are many others who are much, much worse off.”
Perhaps from your vantage point it may seem that way, but that isn’t true.
There are no guaranteed incomes, no guarantee that your patients or their insurers will pay you for work done, no participation in retirement (unless you go to work for the government or a big corporation), no disability insurance beyond what you are able to buy yourself, no employer-paid 401k, health insurance only if you buy it yourself or run a group large enough to get reasonable group rates.
The ignorant and envious presume your income is always high and is guaranteed, but it isn’t. You will only get paid as long as you work, and will be paid well only if you work very hard and even then, there is no guarantee of that. In short, it is like other small business based on skilled services. Except unlike building contractors and tradesmen, and even lawyers, you generally don’t get paid up front.
Unlike other fields, educational costs are much higher, delay to career start is longer and incomes have been more static than in other professions. You will be doing more things at one time than others in different careers who may be intelligent and well-educated but who get earlier career starts at lower educational cost outlay.
The fact that there are others worse off is irrelevant. Take no comfort in that. And don’t believe those who think that past high incomes are some assurance that the future will always be the same.
February 4th, 2006 at 2:02 pm
Jeremy,
Agree with CHenry. Matt doesn’t know Jack. I made less in 2005 than I did in 2004, which was less than 2003, despite working more hours each year and advancing through my 5 year partnership track. I owe 100K from medical school. As an ER doc your earning potential is greatest right near the start and declines as the night, weekend, and holiday hours can’t be sustained with age and family committments. You build essentially no equity in your practice as other specialties might. CHenry is right. There is no employer sponsored retirement, health, or disability plan. You have to see all patients, but they dont have to pay you. The work is hard and booby trapped. I have been at it 5 1/2 years and collected three frivolous lawsuits. One has been dropped, a second will be dropped shortly, and a third has no merit in hell but is still working its way through the court system. The emotional toll is tremendous. A large percentage of people including patients, consultants, and hospital administration are angry and have an overwheliming sense of entitlement. You will be required to do more multitasking and make minute to minute critical decisions than arguably any other career on earth while having incomplete information, shortage of hospital beds, and shortage of nurses.
Matt does not know Jack. I don’t know what fence he is looking over. For the level of service you provide, with the risks assumed, in the austere work environment I predict you will be unequivically WAY WAY UNDERPAID. But hey, I will go to work tomorrow with a smile on my face while the rest of the country gets to watch the Superbowl
February 4th, 2006 at 2:26 pm
“Matt does not know Jack. I don’t know what fence he is looking over.”
I know what fence he is looking over. He is the enemy amongst us. He is one of the sodomites, a plaintiff’s attorney.
February 4th, 2006 at 3:28 pm
“There are no guaranteed incomes, no guarantee that your patients or their insurers will pay you for work done, no participation in retirement (unless you go to work for the government or a big corporation), no disability insurance beyond what you are able to buy yourself, no employer-paid 401k, health insurance only if you buy it yourself or run a group large enough to get reasonable group rates.”
Sure there are. You may not like the reimbursement rates, but you are the best paid profession in the WORLD on average. What’s more, even though it’s not as much as you want, you can sign up to have the government pay your bills. Unlike a building contractor or lawyer, you don’t have to worry about the owner going under.
If the emotional toll is too much, get out. You enter into a profession, any profession, knowing that the stakes will be high because your patients and clients are putting an incredible amount of trust in you and you control their lives to an incredibly large extent. And whine all you want, but you are compensated on average 5x better than the average American worker, more if you’re a surgeon (according to the US Dept. of Labor). If you’re not emotionally prepared to deal with it, then get out. Too much is riding on a professional’s skills.
You don’t like Medicaid/Medicare or insurance, don’t accept it. There are plenty of blogs of physicians who are doing just that who can help you. You don’t like being responsible for all the overhead, don’t take it on. Again, there are physicians who are blogging about that as well who would probably help you.
If the risk is too much, buy some additional insurance or get out. You’ve got a better chance being bankrupted by a lawsuit as a truck driver than you do a physician. And if you can’t accurately assess your risk in that arena, you’re probably not much good at doing it in any other. And since professionals are paid in part to understand and educate their clients/patients on the nature of risk, you’re only doing them a disservice if you can’t determine it.
If you feel underpaid, go work the third shift in a meat packing plant for a few months. Wait some tables. Get a job cleaning rooms at a hotel. That way you won’t have all that pressure and responsibility you’re whining about. See how underpaid you feel on $20,000 a year.
February 4th, 2006 at 3:43 pm
Poor Matt,
So jealous. So uninformed about medical practice. Has to make a living trying to take from others. Jeremy, there are professions worse than EM such as being a ranting lunatic atttorney who makes straw man comparisons in his effort to feed off and destroy the success of others.
February 4th, 2006 at 5:09 pm
At 3:28, Matt wrote:
>”Sure there are.”
Really? Exactly where and how? If you are referring to my patients, well, no one guarantees they will come to my office, ever. I have to work to build my reputation and their trust. Every day.
>”but you are the best paid profession in the WORLD on average”
Maybe in your “WORLD”. Otherwise, that is utterly meaningless and unverifiable. Sorry to say, we don’t get paid by some magical paymaster based on statistical income averages. What are you referring to, pay to family practitioners or orthopedic surgeons? Weighted averages or not? Recent data, or not? All occupations, or a select group of professions (perhaps excluding dentists, whose last average income stats exceeded that of physicians, at least in the USA)?
>”Unlike a building contractor or lawyer, you don’t have to worry about the owner going under”
I am no more guaranteed payment when the patient is uninsured than the examples you give here. I don’t get to pre-qualify or demand letters of credit most of the time, either. What is more, I can’t seek a mechanics lein against an unpaid debt. Even when the patient is insured, I am not guaranteed to be paid. The insurers even say that.
>”If the emotional toll is too much, get out.”
Please show me where I ever suggested anyone get out. I am not planning on quitting.
>”You don’t like Medicaid/Medicare or insurance, don’t accept it”
Thanks for the sage advice, I would never have figured that out without you. Plenty of other doctors have already voted with their feet on Medicaid, for reasons I have stated above, and some are doing the same on Medicare. I have dumped some private insurance companies whose pay policies I didn’t like. If Medicaid and Medicare became unacceptable, I would do the same with them, too.
>”You’ve got a better chance being bankrupted by a lawsuit as a truck driver than you do a physician.”
Show me. I don’t believe you otherwise.
>”If you feel underpaid, go work the third shift in a meat packing plant for a few months.”
Why should I? And whatever made you think I would respond any less rationally to economic incentive than anyone else? Matt, you seem to burn with indignation and resentment at doctors, as if you think that because there are others whose work–perhaps because it is less skilled or less risky–is not as well paid as mine or yours that it is unreasonable to even discuss reimbursement issues. Sorry you feel that way, but the rest of the world generally doesn’t.
>”Get a job cleaning rooms at a hotel.”
I have done those sorts of jobs, Matt. I like mine better. If that is your way of trying to shut me and others up, well, forget it.
>” That way you won’t have all that pressure and responsibility you’re whining about.”
Where have I complained about pressure and responsibility?
Matt, if you want to be an angry self-righteous crank, that is your privilege. Have fun with all that. When you blow off meaningless, unverifiable and unbelievable “statistics” to fortify what you say, you aren’t convincing me. You have implied that physicians are guaranteed their incomes, which is laughably untrue. Then you say that they earn more than any other profession in the world, which is contrary to other recent income statistical reports I have read. And you conveniently omit the opportunity and educational costs to qualifying to earn a professional, which further gives the lie to your words.
February 4th, 2006 at 5:10 pm
Matt (Or are you CJD in disguise?),
Thanks for all the counseling tips. What is your fee? You have quite a command of EM practice inaccuracies that I won’t take the time to try to educate you about.
I have not worked in a meat packing plant, but I have worked the third shift in a Crown Pacific sawmill, scraped paint, cleaned and painted campground latrines for the USFS, been a timber faller, bucked hay, shoveled horseshit, worked as a short order cook, cleaned microbiology test tubes, laid cinder block, and taught school as I worked my way through it. I don’t have just a singular perspective. Been there, done that.
The Dept of Labor statistics don’t tell the whole story. An annual salary of 150 or 250k from a plaintiff attorney perspective must look like “WOW a greedy doctor that I need to take something out of”. But the annual salary does not take into account the high startup and investment time costs, as well as high annual practice costs (licenses, CME, etc) that are a personal expense.
Tell me this. If I hired you as an attorney would my “emotional distress” from a frivolous lawsuit be any less real and important as the emotional distress caused by an 10 hour delay in diagnosing appendicitis that resulted in no damages? Would you fight with such vigor for whoever is paying you, or is it just a matter of principle that you dislike physicians and that their distress and concerns is somehow not really real?
February 4th, 2006 at 10:19 pm
“You’ve got a better chance being bankrupted by a lawsuit as a truck driver than you do a physician.”
Even if that is true, just because you guys are sodomizing other professions for your own greed doesn’t make what you’ve done to medicine right.
“You enter into a profession, any profession, knowing that the stakes will be high”
When I got in, it wasn’t this litigous. As ER’s got busier, patient care got thrown right out the window. Now practicing “Defense” is all we have time to do. It effects patient care. Matt, your profession is killing people.
February 4th, 2006 at 11:06 pm
“Maybe in your “WORLD”. Otherwise, that is utterly meaningless and unverifiable. Sorry to say, we don’t get paid by some magical paymaster based on statistical income averages. What are you referring to, pay to family practitioners or orthopedic surgeons? Weighted averages or not? Recent data, or not? All occupations, or a select group of professions (perhaps excluding dentists, whose last average income stats exceeded that of physicians, at least in the USA)?”
My world is the USA, which includes the Dept. of Labor. Parse the statistics however you want, but it doesn’t change the facts. On average, physician is the highest paid profession in the world. As for guaranteed income, you clearly don’t appreciate what it means to have a paymaster that never goes broke and can print its own money. Go read the blogs of those who do.
“Show me. I don’t believe you otherwise.”
If you’re a truck driver and you’re in a wreck of almost any kind, your chances of the resulting injury being significant enough to kill or seriously injured, and thus leading to the kind of damage award that could bankrupt you are incredibly high. Plus, since you likely don’t make as much as a physician, if you’re self employed you probably don’t carry as much insurance as a physician. Whether you drive local or OTR. Now, tell me how often the average podiatrist has that chance.
In fact, out of the million+ physicians in this country, how many have ever been bankrupted by a lawsuit? I realize this is a fear of you guys, but how often does it really happen?
“Matt, you seem to burn with indignation and resentment at doctors, as if you think that because there are others whose work–perhaps because it is less skilled or less risky–is not as well paid as mine or yours that it is unreasonable to even discuss reimbursement issues. Sorry you feel that way, but the rest of the world generally doesn’t.”
I have no indignation or resentment. I think you should be paid well because you do a difficult and demanding job. I just don’t like whiners.
“If I hired you as an attorney would my “emotional distress” from a frivolous lawsuit be any less real and important as the emotional distress caused by an 10 hour delay in diagnosing appendicitis that resulted in no damages?”
How many med mal cases do you think there are with no actual damages? You’re illustrating physicians’ ignorance of the law. Considering the cost of bringing a med mal case, why would anyone file the case?
“Then you say that they earn more than any other profession in the world, which is contrary to other recent income statistical reports I have read.”
Cite the source, then. As for professional fees and opportunity costs, etc., again – quit whining. Or better yet, go tell your sob story to those who are working those jobs you guys left long ago. See what kind of response you get from real people. Your lives have clearly become too insulated.
“Has to make a living trying to take from others.”
Actually, I work at giving back what you took from them. The injury people like you caused with your negligence and the damage that results. Maybe that’s why you never talk about the victims – they never meant anything to you in the first place.
February 4th, 2006 at 11:10 pm
But back to the point, it’s all going to be moot in 5-10 years anyway, because while you’re pissing and moaning about lawyers and how miserable you have it, we’re marching inexorably on toward universal health care.
You might want to get over your lawyer fear/obsession (and for ds, his ass obsession) which leads you to do the insurers’ bidding and start focusing on the real train coming down the tracks. You haven’t got much time left to stop it. Or go to one of those countries’ whose legal systems you love so much and practice there so you’ll be used to it.
You’ll get your limited liability workers’ comp style system and your reduced if not eliminated malpractice premiums, but it will have a price. You sure you want to pay it?
February 5th, 2006 at 12:14 am
Bingo! That last comment settled it for me! I think Matt is actually Doc Elliot! I don’t think he’s CJD because even though he’s stuck in a gutter profession, he doesn’t seem to resent/hate doctors and makes some redeeming comments. Elliot seems to think we won’t accept lower wages if it means saving our healthcare system from parasites like him. Many physicians (including me) have responded on Kevin’s website that we’d be happy to take pay cuts in exchange for tort reform. You can cut my salary 40% if it means I could take care of patients instead of sodomite lawyers.
February 5th, 2006 at 2:18 am
For the record, Matt, or MattBish, is CJD. Our favorite unemployed plaintiffs’ attorney.
February 5th, 2006 at 6:42 am
Hooray for lawyers.
Matt’s comments are revolting. How can you look at yourself in the mirror, man?
Flea
February 5th, 2006 at 7:01 am
Flea,
Don’t shoot the messenger. I haven’t made one statement that was false.
The truth is sometimes ugly for those who haven’t faced up to it, I understand. But it’s never a problem looking yourself in the mirror when you’re telling the truth.
February 5th, 2006 at 7:04 am
“You can cut my salary 40% if it means I could take care of patients instead of sodomite lawyers.”
This comment illustrates just how well paid you are. If you would trade away 40% of your salary, that’s a hell of a salary. Your insurance premiums certainly don’t constitute 40% of your salary.
You should DEFINITELY quit whining. Although I doubt you will, because your ass obsession appears to be how you define yourself.
February 5th, 2006 at 7:05 am
Grunt, if I’m unemployed because I have time to make comments and educate physicians, since you post in this blog daily, does that mean you have literally nothing else to do whatsoever?
February 5th, 2006 at 7:33 am
I thought I smelled CJD.
I would also gladly take a pay cut if it meant some meaningful tort reform. I paid approx 40K this year for my modest malpractice coverage, but I’d pay more to be totally indemnified. What does your legal malpractice insurance cost you a year, CJD?
Playing the public-resentment-of-rich-doctors game seems to be your favorite rhetorical gambit. As for telling our “sob story” to “real people” (implying, of course, that we’re not real people, just faceless, bottomless deep pockets, waiting to be fleeced), plenty of my patients appreciate how long I went to school, and how well I treat them.
But that’s OK. We’ll see what kind of “whiner” you are when you have your next kidney stone. Pain is pain, buddy… but I’ll gladly hold back on that morphine so you can show off to your colleagues how you don’t whine. You say the word, and I’ll let you scream/writhe/puke so you can tell them you “took it like a man.”
Just out of curiousity… do you say the same thing about the clients who attempt to retain your services? All that “whining” about pain and suffering after all… how do you stand it?
February 5th, 2006 at 8:56 am
New Guy, you didn’t really read my posts, did you? I’m glad you make a lot of money – I think you deserve it. Not once have I said that you didn’t work hard for it or earn it. Read what I wrote, not what you want me to say.
Do you object to someone arguing that you’re just a rich souless person after another dollar? That you don’t care about those you work for or on? Welcome to the club. Do you object to it when physicians say the same about others? Do you object when one of your colleagues uses terms like “sodomite”? I’m sure you do, because you wouldn’t want to be considered a hypocrite, would you?
As for the whining, what’s sad about it is that you all feel so totally ineffectual, so whining appears to be all you do. Most of you don’t appear to have the slightest clue what to do about your declining reimbursement rates. Don’t you wonder where your AMA “crisis map” is on this issue? Do you not have talking points unless an insurer supplies them to you?
We just had a Republican administration pass, almost without objection, the largest entitlement program since the Johnson era. And we’ve got big business screaming for health care relief. Universal health care is about to be a foregone conclusion, and all you guys appear to have the ability to do is curse lawyers. Your malpractice premiums will be a drop in the bucket compared to the income lost, not to mention the wholesale changes in your practice, when that happens.
But what are you doing about it? What is one of the potentially most well funded groups of people in the United States, who have more at stake if universal health care becomes a reality than anyone else, doing to stop this? Or do you want it? What’s the AMA doing on this front? Where are the vitriolic letters to the editor? Where are the crisis maps, the empty claims of physicians leaving and people going untreated as a result, the marches on the state capitol? What do you think is going to have more of an impact on your bottom line – keeping a few people who have been hurt really bad from getting fully compensated or Washington completely running your billing?
Is it too complex an issue? Is there no easy party to demonize? What’s the deal? This is the real issue. The baby boomers are going to hit and the strain on US health care is going to be enormous. Do you really think any politician is going to let GM go under because of healthcare costs? They have 1 million workers whose health care they are providing for. And that’s just GM.
Incidentally, I paid about 4% of my income in malpractice premiums last year – about what the average physician pays. If I handled complex and costly cases like med mal on a regular basis, it would have been significantly higher. If you want to be “totally indemnified”, buy more insurance and do just a little bit of asset protection planning. While no one is totally and completely indemnified, you can come damn close. I warn you, though, you will have to speak with an attorney to do so. If you’re smart, you’ll talk to a plaintiff’s malpractice attorney to get a better idea of exactly what your exposure is.
Like I said, I believe you’ll get your wish of complete indemnification. But I bet you won’t like the price you pay for it.
February 5th, 2006 at 10:54 am
Regarding physicians being the best paid profession in the world, has anyone looked at the hours dedicated by physicians? Would any other profession get out of bed at 3 in the morning to go to the ED in a winter’s storm to evaluate a patient with belly pain who has no insurance and will probably not pay the physician and then probably sue the physician if the outcome is less than perfect? Granted the average plastic surgeon is living a very comfortable lifestyle, but not the average physician. This will become more evident as the numbers of physicians decrease in the future. I am only in my 50’s and had planned to practice medicine well into my 70’s like my father before me. However, I will close my practice next year and join a corporation selling medical devices. No, it won’t be satisfying, but at least I won’t have the fear of losing my house and my wife’s and children’s financial security. I’ll probably join a few medical missionaries abroad to keep a hand in clinical medicine. And will my patients lose out? You bet, but that’s the world we have all created.
February 5th, 2006 at 11:00 am
Matt (CJD)
Healthcare is failing for many reasons. The legal system is just one aspect. You consider yourself far too important. I would look silly trying to lecture a bunch of attorneys bout their practice and their profession. You look perpetually silly trying to do the reverse. If you don’t like listening to whining then don’t, but I think you enjoy the attention you get. We have heard all your talking points. Go lecture your dog, or your kid, or help someone with estate planning.
“How many med mal cases do you think there are with no actual damages? You’re illustrating physicians’ ignorance of the law. Considering the cost of bringing a med mal case, why would anyone file the case?”
I don’t know. For me personally, it has been 5/5 cases that were frivolous, without merit, and without liability. I understand that verdicts are filed for the defense majority of the time. You probably have some up to date statistics. If you trust the court system then the majority must have been frivolous and without merit. Bad outcomes yes, negligence NO. I think it would be much harder to figure out for cases not going to trial since there is not a jury decision. Clear cut negligence cases are likely settled as a higher percentage, but a very large number are also settled just to get rid of the nuisance. Maybe because you are more practical, or more ethical, you have only done three cases of med mal that had clear liability and settled. You don’t have the money and resources to take those frivolous cases to try and hit the jackpot. Is that because you are more practical, ethical, realistic, than the bigger sharks? Maybe you should try and “educate” them if you are so concerned about the impact of the legal system on the healthcare delivery.
February 5th, 2006 at 11:06 am
“No, it won’t be satisfying, but at least I won’t have the fear of losing my house and my wife’s and children’s financial security”
If you have this fear it is because you have failed to adequately insure yourself and have failed to sit down and consult with either a lawyer or financial planner who can explain very basic asset protection strategies. There is not a state in the union that allows your home to be taken by anyone but the primary mortgage lender, unless you have a ridiculously expensive home. The fact that you don’t know this indicates that you need to do some investigation. You may be quitting a job you love for the complete wrong reasons.
The world you believe has been created is not in fact the world that exists.
February 5th, 2006 at 11:20 am
Jerry,
I do not consider myself important at all, and I am not lecturing you on anything. Really, it makes me sad to see a group of people feel so helpless, and if you can look past your irrational hatred of lawyers, you might see that your lobbying organizations are failing you.
I have no doubt many of you have been named and dropped in lawsuits, and have probably wondered why. It’s because one, there are some attorneys who just scattershot name everyone when they shouldn’t. No doubt about it. But a lot of times its because you can’t tell who to eliminate until you’ve done some discovery. And I doubt any of you are willing to go under oath about a patient before suit is filed. If a lawyer could request medical records and clear up their case and focus it prior to filing, either through pre-suit depositions or receiving detailed affidavits from the physicians who saw the patient, many would. Since the plaintiff’s lawyer isn’t paid by the hour, it’s a waste of their time and their money to have multiple defense lawyers for multiple doctors on the case and sending them discovery requests, correspondence, etc. But I don’t think many of you will talk to a lawyer about a patient pre-suit, will you?
The other problem is the incredibly short statute of limitations for medical malpractice, which by the time the patient comes to the lawyer, often leaves no time to do in depth discovery. But I doubt you want to lengthen the limitations period, either.
“You don’t have the money and resources to take those frivolous cases to try and hit the jackpot.”
Why do you refer to those victories as “jackpots”? Has the lawyer not worked for his fee? Has the victim not suffered? Would you trade places with many recipients of a $1 million med mal verdict? These jackpot winners? Would you put tens of thousands of your own money at risk and months of your time on the bet you could win a med mal case like their lawyers? Knowing how often you will lose? I get that it’s a cute turn of phrase to make is look like every plaintiff is getting undeserved money, but do you really believe that?
” Maybe you should try and “educate” them if you are so concerned about the impact of the legal system on the healthcare delivery.”
What you don’t understand is that in the great scheme of things the impact of the legal system on healthcare delivery is minimal. The price of healthcare to the consumer goes up regardless of tort reform. Heck, the best you can hope to do on premiums even is to “slow the rate of growth”.
Lawyers can’t make you do a better job. If you want to change the legal system, here’s a suggestion: Start putting out guidelines for the standard of care. Why are physicians not reviewing malpractice cases looking for trends and then establishing standards of care that they will live by and which courts can rely on? I realize every case is unique, but there have to be common themes.
You’re right though, my pleas are probably falling on deaf ears. But one doesn’t have to be a physician to understand what’s going on in healthcare and to recognize the political realities of the situation. I for one do not want universal health care. I do not think it is a good solution to any of the problems. It’s just frustrating that those in the best position to do the most about it are pissing away their time on something that is really only a benefit for insurers and really only a negative for the people who are injured the worst by legitimate malpractice. It doesn’t harm lawyers and doesn’t really help doctors.
Maybe you just don’t care, though.
February 5th, 2006 at 11:21 am
“This comment illustrates just how well paid you are. If you would trade away 40% of your salary, that’s a hell of a salary. Your insurance premiums certainly don’t constitute 40% of your salary”
Again CJD, you’re changing the subject. Whether I make $20,000 a year or a million, the fact that I (and most doctors) would be willing to give up a portion so that we can do what we loved before lawyers ruined it shows how good medicine could be if we could just get this legal monkey off our backs. Your profession has made physicians afraid of the very patients we are supposed to be caring for. So we hide, try to avoid “high risk” patients, and lawyers have created a “cold war” between physicians and patients. I’m afraid to go to work every day, lest a patient has a bad outcome and I get sued. If 40% would allow me to want to see patients again, I’m all for it.
February 5th, 2006 at 11:27 am
Goodness, everyone of you Drs., speak of patients, as though we are all waiting for you to make a mistake so that we can hire Matt to sue you.
In reality, how many of your patients have filed lawsuits against you? Do you think lawyers are going to take on a lawsuit that they believe has no merit? How many hrs. do you imagine they spend preparing for a trial? How much money do they spend on investigators? How many witnesses do they have to speak with? You pretend as though you believe someone walks into their office and says “I’m pissed at my Dr. and I want to sue him.” The lawyer then says “OK, lets go for it, I will file the papers and see you at trial.” Give me a break! You are turning pts. against you with your defensive medicine attitude. You order tests and procedures that you know we don’t need, then you get angry if we don’t pay, or our ins. doesn’t pay you for all this BS. Why not just try honesty with your pts.? Tell us if there is a test that “could” be done but your expertise and education tells you that it probably won’t show anything, then leave the decision to us as to if we want that test or not. For the most part, we come to you because we trust you and we believe in you. You are taking away all that trust!
February 5th, 2006 at 11:34 am
Again ds, your comments illustrate that you really have no idea of the risk entailed in what you do. If I were you I’d want to know someone other than the AMA and my insurer, but you seem content to unquestioningly rely on whatever they tell you.
If you could happily afford to give up 40% of your salary, why don’t you just use some of that to buy a $10 million malpractice policy? The chances of you having a verdict in excess of that are infinitesimal. And you can make them even smaller with just a little bit of money spent on asset protection.
If you really want to put your mind at ease, speak with a good tax/corporate attorney, and then talk to a malpractice lawyer on both the plaintiff’s and defense side. Only a fool would rely solely on an insurance company and lobbyists to tell him what is in his best interest.
I mean this in all sincerity, you do need some help because you are scared way out of proportion to your exposure. And I don’t think you should be so willing to give up your hard earned money.
February 5th, 2006 at 11:39 am
“Would you trade places with many recipients of a $1 million med mal verdict?”
Lots of people suffer. I have a cousin who is 19 years old and cannot function because of intractable seizures due to Neurocysticercosis. I have had to tell parents their 2 year old was dead. But to reward a few (and their lawyers) and destroy an entire profession in the balance (ie OB-GYN) to reward a minority of “victims” is insanity. In the ER, we get sued most often for errors of ommision, so we test, test, test, to the point that we cannot handle the volume of patients we see(and their defensive test workload). And we still miss the “needle in the haystack” and get sued anyway. I am not going to pick up every single disease that walks into my ER, and I test more then almost every doctor I know. But I will miss something and get sued. Why do these tragedies have to be equated with monetary reward in this country?
February 5th, 2006 at 11:51 am
“Goodness, everyone of you Drs., speak of patients, as though we are all waiting for you to make a mistake so that we can hire Matt to sue you”
We have to think that way. I put my name on approximately 5000 charts a year. I will get sued for approximately 1/25,000 patients I see. (once every 5 years) So it’s unfortunate, but I have to treat all 25,000 patients defensively to save my butt one that one who sues me. I can’t predict who that one will be, so I treat all 25,000 like they will be the future plaintiff. Every ER doc (and OB-GYN, Orthopod, general surgeon) I know practices this way.
As to offering tests and letting the patient decide, we do this every day. We then are forced to tell them “If you don’t do this test you are at risk of dying” , If you refuse I need you to sign out AMA, which is antagonistic, but I never lie to a patient, I tell patients “in emergency medicine we often look for needles in a haystack”. Unfortunately alot of patients don’t understand what I am telling them, and they agree to the defensive test that I would never agree to myself (ie Lumbar Puncture for headache, “just in case” it’s a subarachnoid)
February 5th, 2006 at 12:36 pm
This goes deeper than your mistrust of lawyer’s, and your fear of that 1 out of every 25,000 patients. You are making broad statements pertaining to the entire judicial system. Aren’t you allowed to hire your own qualified attroney’s if you are being sued? Aren’t you granted the right of a jury trial and your attorney allowed to question each potential juror before he/she is excepted? Why aren’t you allowed to present your defense in front of the jury and prove your innocence? If I was being sued and hundreds of thousands or millions of dollars were at stake, I would hire the best defense attorney available to me. If I had done nothing wrong I would not be intimidated by a lawsuit, I would fight my ass off to clear my name.
The fact that patients and their attorney’s are granted millions of dollars at these trials is way over board, but is that the norm in a malpractice trial? I doubt that it is. We only hear about the few that do receive that type award.
I once had a Dr. (surgeon) that was being sued by another patient. This Dr. informed myself and my husband 2 weeks before my surgery of this lawsuit. He explained it in some detail to us, because he wanted me to be aware of it before I agreed to to have surgery. It didn’t matter to me in the least. We had a good Dr./Pt. relationship and I willingly wanted him to operate on me. I gained much respect for him that day for making sure I knew about this lawsuit. I thought it was probably very hard for him to inform his Pts. about it. We never spoke of it again and I never knew what the outcome was. I continued treatment with him for 5 years. His office was always packed . He was an oncology surgeon so this was a long term raltionship. He saved my life. Millions of dollars couldn’t have compensated him for what he gave back to me.
I can plainly see your side of this, but, something has to be done
before your fear of lawsuits destroys your profession.
February 5th, 2006 at 12:51 pm
Ds,
You’ve moved away from the risk question, and I hope you take my advice, because it would do you a lot of good. But you do bring up another issue, although you’re still a bit overwrought, when you say this:
“But to reward a few (and their lawyers) and destroy an entire profession in the balance (ie OB-GYN) to reward a minority of “victims” is insanity.”
Why should these people get any money? Why should the victim of a car wreck get any money? Or the victim of a faulty product? I think it’s because we as a society believe these things have value. And the only way we can compensate those losses is money, the one thing that we all agree does have some value. It’s not perfect by any means, and no one disputes that. But we are simply not willing to say that it lacks value.
The next thing is personal responsibility. If you harm me, and cause me damage, why shouldn’t you have to take responsibility for that? Why shouldn’t my medical bills as a result of your actions, be they driving a car or performing surgery, that fall below the standard of care? I didn’t cause the injury.
The third thing is related to the second – allocation of resources. You see a $1 million verdict and think that person just got a million dollars, less attorney fees. But they didn’t. Their health insurer got some, their future medical providers get some, their mortgage holder likely gets some, the lender on their car gets it. The award, by requiring the person responsible to pay, keeps all those other people solvent, and keeps the injured person off the welfare rolls in the case of catastrophic injuries.
You’re right though, we could not award any money for anything. But then why would we need insurers?
Now, in the case of your examples, we can’t collect on God. You’re right, sometimes crappy things happen, and Americans know it. In fact, the number of tort claims has declined over the last decade.
As to your claims that you MUST do defensive medicine, they are, like your risk assessment, faulty. Or at least uninformed. Do you have any ideas which missed tests are most likely sued upon? Do you know what the likelihood of success in those cases are? I’m betting you don’t. So you’re just performing these tests willy nilly, with literally no comprehension of whether they are actually doing you any good.
And really, if you buy that $10 million policy and do your asset protection, why are you afraid to tell the jury exactly how your actions met the standard of care? You’ve got a pretty good shot of winning as it is.
With regard to your examples, was their suffering the result of another person’s negligence? Your
February 5th, 2006 at 2:52 pm
“As to your claims that you MUST do defensive medicine, they are, like your risk assessment, faulty. Or at least uninformed”
It really shows how little you know about what goes on in Emergency Medicine. It’s my full time job. Defensive medicine is what we do. We practice risk assessment 24/7. I’m not just some outlier, obsessed with lawsuits. I’m just one of the few with the kahunas to say it. We see a ton of patients with complaints, more then the system can handle, our job is to decide who is “at risk” of a bad outcome, and deserves that test today. Most of us admit the majority of patients with chest pain, not because they have a high likelihood of disease, but because missing an MI is so “high risk”. If most ER docs knew that abdominal pain in the elderly was even higher risk, they would be more defensive about those patients too.
“Do you have any ideas which missed tests are most likely sued upon ”
It depends on the patient population. The most likely lawsuit from a missed test in all comers is a missed fracture from a misread xray.
In Kids you don’t want to miss Meningitis or appendicitis. So the missed tests that get you sued in kids is Lumbar Puncture (for meningitis) and whatever test your hospital does for appy in kids (Ultrasound, Ct Scan). A new source of income for lawyers is the delayed diagnosis of meningitis, ie you do the lumbar puncture, but it causes delay in giving antibiotics.
In adults the big misses are Missed MI and Missed Subarachnoid hemorrhage. Failing to admit a patient with chest pain is a big error of ommision. Failing to do a CT scan (and LP) on a headache is another big winner for the lawyers. Most ER docs are being very defensive about doing these tests, though LP continues to be a problem due to the time it takes to do.
Omitting treatments is another big source of income for lawyers, especially since so many treatments, ie TPA for stroke, is so controversial. Delays in treatment are creating further wins, as the system gets more and more overwhelmed, for example USC lost a huge lawsuit after a guy with DKA got fed up of sitting in the waiting room, went home and died at home. He never saw a doc but the lawyer dinged the hospital for the wait.
February 5th, 2006 at 3:30 pm
What I’m asking is if there are any studies that you know of that indicate which tests, when not given, have been determined by a jury or a court to be part of the standard of care for the particular complaint?
You say you practice risk assessment 24/7, but you do it without any baseline. You can’t tell me a single thing based on anything other than anecdotes about what act or omission leads to a lawsuit.
You’re making all these claims about this or that being big moneymakers for the lawyers (as always, forgetting that someone was actually hurt by the negligence), but they all appear to be based on one, maybe two cases you read about in a newspaper. What is the source for your claims? So and so told you about this case? A friend of a friend?
If I were as stressed as you, I’d want some hard statistical evidence on how to lower my risk. For some reason, it does not appear any effort by physicians has been made to review the cases out there and determine where care is being found to have fallen short consistently, or to create some firmer guidelines for the standard of care that all physicians can count on. If nothing else, you’ll be able to tell where expert witnesses are giving false testimony. All this stuff appears to be done on an ad hoc basis now, leaving you with nothing more than anecdotes.
The anesthesiologists did just that, took a hard look at where the verdicts and settlements were coming from, and improved the quality of their services. I realize they are not ER docs, but surely you’re not saying there is NO room for improvement, and NO need for some firm guidelines on what constitutes the proper care.
The information is out there – the insurers have all the medical records from every case. Granted, it won’t work for all cases, but no one appears to have even tried. Has it occurred to anyone that instead of just demonizing lawyers, actually trying to improve quality might yield some results? Who in your industry is studying these sorts of things? What is the AMA for? Just lobbying on behalf of med mal insurers?
February 5th, 2006 at 6:08 pm
There is statistical data on exactly what DS mentioned, CJD… you know it as well as I do. I’ve seen it, and I know you have too. Most risk-management folks in the hospital (or your insurer) have those numbers. I don’t have them at my fingertips, but the last time I went over them, they dovetailed exactly with what DS just wrote.
There is good data for what particular diagnoses bring in the big cash for med-mal cases (missed MI is always at the top of that list). The tests for those diagnoses are pretty standard, and it’s those tests (like LP for SAH) that DS is talking about.
I loved your suggestion to just buy more insurance, BTW. My group could only find 2 companies that would even talk with us (many companies are NOT interested in carrying ER docs under their umbrella… we’re too high-risk).
That 40K per year that I’m paying? (which is a hell of a lot more than 4% of my income) Yeah… that’s for 250/750 coverage, with no pending suits, and nothing in the last five years. I strongly doubt that 10 million in coverage would even be economically feasible for me. And how is that 10 million coverage going to indemnify me when the insurer is likely to drop me (or double my already-astronomical rates) after a single payout?
There is a double-edged sword with carrying more insurance, and I’m quite certain you’re not ignorant of it. The first question every plaintiff’s attorney asks is “what are their policy limits?” It’s common to aim as high as you can (sometimes for the policy limit in particularly bad outcomes) to maximize payout, and so that any subsequent settlement offer appears more reasonable. Also, simply settling out of court, whether to make a frivolous suit go away, or to avoid a big payout, can get you labeled as somebody who won’t fight. It’s very, very bad to get a reputation as a “payer;” nothing attracts sharks like blood in the water.
I could simply protect my assets and go bare, but my hospital won’t allow it… they don’t want to be the only “deep pocket” when the local PI attorney comes calling.
February 5th, 2006 at 6:50 pm
“The anesthesiologists did just that, took a hard look at where the verdicts and settlements were coming from, and improved the quality of their services.”
I just love this one. What does an anesthesiologist do when he has a difficult intubation in the OR? He cancels the case. Patients are NPO and prepped for surgery. Patients I see who need to be intubated are near death, have a full stomach, and usually just had a liter of vodka. But of course CJD’s world is like the anesthesiologist’s: The controlled, aseptic environment of the courtroom, where the only subjective thing is the emotions of the jury.
Regarding proof of which cases you lawyers make big money on, are you f-ing kidding me? Why do you think lawyers go after OB-GYN’s so often as compared to psychiatrists? Because all the stupid, fumbling docs went into OB-GYN? Why are there 500 lawyers out there who specialize in “birth injury”, and none who specialize in “missed cases of depression”. Cause that’s where the money is. I can point to at least 10 studies which will show you that Missed MI is the biggest breadwinner for the lawyers in emergency medicine. As for a single specific “test”, it would be impossible to study. Having now seen over 50,000 patients, I think I can say in my professional opinion the most “missed test” is the CT Scan for appendicitis, since there is no specific test for MI. I don’t use “the newspaper” or a “friend of a friend’ for my medical education or information. As I said, there are many studies which show the payout rates based on the missed diagnosis, but I certainly am not going to list my references when I’m arguing with CJD. If you really want to learn this stuff get out of the gutter and go to medical school. Or you can look it up yourself.
February 5th, 2006 at 7:16 pm
Jeremy,
Are you still listening to this? See what ignorance you are up against? Have you scrambled out of your match choices? CJD’s ignorance of medical risk assessment is almost as funny as his trolling of medical weblog sites changing his pseudonym. He apparently is not aware that the majority of clinical medical school and residency is a continuous study of pre and post test probabilities of disease based on results of established and evolving technologies, the risk assessment of missed diagnoses, cost effective analysis of diagnostic tests based on prevalence of disease and on and on and on and on. A large portion of continuous medical education is dedicated to medicolegal risk asssessment, statistics, and avoidance. He wouldn’t know that, I wouldn’t expect him to, but what a baffoon to presume to know. While you work in the real world and take care of real people (meat cutters and truck drivers), uninsured, illegal aliens he will be stuck in his alternative universe. You will sweat bullets in the middle of the night doing your best to take care of everyone with limited resources, backup won’t be there, and CJD and his crazy ass kind will be waiting for the kill. Ever watch the Jackals on Animal planet?
February 5th, 2006 at 9:33 pm
Exactly what I wanted to say Jerry, well put. If you’re interested in evidence based studies that show rates of malpractice based on diagnosis several such studies have been published in Annals of Emergency Medicine.
February 6th, 2006 at 8:07 am
“Ever watch the Jackals on Animal planet?” -ds
Come on, that is an absurd comment. I’m a physicist and a complete outsider to this debate, and from my point of view there is merit on both sides of the issue. If a doctor commits harm to a patient through gross incompetence, I think most reasonable people would agree that the patient deserves some monetary compensation. That’s the way our legal system works – the world is obviously not fair, but the legal system tries to create a more just outcome when possible. The lawyer who helps the injured patient receive reimbursement is not morally equivalent to a jackal.
“For some reason, it does not appear any effort by physicians has been made to review the cases out there and determine where care is being found to have fallen short consistently…” -Matt
This comment also does not make sense to me. As I understand it, the point of much medical research is to improve care, especially in cases that consistently fall short. ED doctors should not be responsible for economic analysis of malpractice litigation, and neither should the AMA. It’s not clear that the most common misdiagnoses (or omitted tests) would even coincide with the highest-settlement misdiagnoses (or omitted tests).
Anyway, on the whole I’m satisfied with the system at the moment, doomed as it may be. There will always be occasional miscarriages of justice leading to excessive compensation, but there are certainly numerous patients unaware of or uninterested in their right to sue, and possibly even unaware of damage caused by incompetent medical practitioners.
The threat of malpractice suits helps to focus doctors on the most commonly misdiagnosed problems, and may also help by forcing doctors who can’t handle high stress levels out of certain practices. The drawbacks seem to be extra costs to the system, possibly more impersonal and “defensive” medical care, and a less pleasant work environment for the doctors.
February 6th, 2006 at 10:05 am
Danny,
I’m not sure many non-physicians appreciate the true costs of our current malpractice system, and the attendent defensive medicine costs. They’re huge… billions of dollars if they’re a dime. We order MANY tests, and admit MANY patients to the hospital in attempts to exclude unlikely-but-potentially-ruinous diagnoses, all in an attempt to stay out of the courtroom.
Malpractice cases are decided in favor of the physician somewhere around 80% of the time at trial… and that doesn’t count the ones that are dropped, or settled to make them go away. If one assumes that the courts/juries generally get it right, then the vast majority of malpractice cases are without merit. Those cases suck billions and billions of dollars out of the healthcare system in attorney’s fees, expert witness fees, malpractice premiums…
Also, those cases that are actually filed are only a tiny fraction of the medical errors that are committed every year. Is it because all doctors are incompetent quacks? No… it’s because we’re human, and medicine is mind-bogglingly complex. I’ve met some of society’s finest minds in some of my colleagues, and even the BEST don’t get it right 100% of the time.
CJD takes a lot of abuse on forums like these (and some of it he brings on himself), but it’s not really all his fault; his existance, while repugnant to many physicians, is only an expression of a deeper problem. CJD exists because we have unrealistic expectations as a society.
We expect that people will live out their whole lives without pain, injury, or suffering. We expect that our wealthy society will/should be able to care for everyone, regardless of their behavior or pathologies… and if we don’t? Then By God, somebody’s going to pay. That lust for vengeance is a defect in our national character, and it’s in all of us, whether we like to admit it or not.
CJD believes that he restores what was lost, and that he dispenses justice to the wronged… and he can be pretty self-righteous about it (as can physicians), but that justice is selective. I don’t know too many PI attorneys who’d take a case where the party was legitimately wronged, but is an abrasive, raving lunatic on the stand. If, like an ER doc, CJD took every case that walked in the door, he’d probably get a lot more respect here (”but I can’t afford that!!” he cries… ah, yes…). However, like most, he is out to make a profit, so he cherry-picks. But what about the others? Are their cases any less deserving? Even with as many cases as our current system files, it allows meritless cases to stay in the pipeline, while leaving other wronged parties out in the cold. Should we compensate all of them? Can we even afford that?
As our current system is painfully adversarial, wasteful, incredibly expensive, and has badly corroded doctor/patient relations, What we need to ask ourselves is this: How can we, as a society, reform this system to take care of this issue? Multimillion dollar verdicts for everyone are NOT the answer.
The involved physicians are not objective, and the hired guns sure as hell aren’t either.
I think we need a malpractice court. It might leave a lot of PI attorneys unemployed, but if all they’re doing is filing meritless cases…
February 6th, 2006 at 10:41 am
New Guy,
Nicely said.
Danny,
Nicely said. We well understand the issues of the other side. It is easy to get vehement from your own viewpoint in an internet weblog. In my reletively short career 5/5 lawsuits filed against me were completely meritless. I couple were easily dismissed. In the others I literally did every conceivable thing possible under austere conditions for the patient. Having been through the court proceedings “jackels on Animal Planet” is not such an absurd metaphor. I have been there. They took some flesh from my hyde, but I will survive.
February 6th, 2006 at 11:45 am
Three years ago, even though I am a medical librarian, I was chosen to sit on a malpractice jury. When we got down to deliberations after 4 1/2 days, it turned out that 4 of the 6 of us had realized that it was a defense verdict before the first plaintiff’s witness had finished.
Note to lawyers:
If your two expert witnesses can’t agree on the cause of the malpractice, you might have trouble convincing a jury.
If you sue the GI, but not the surgeon to whom the GI refered your client, who saw him/her in between his/her last GI visit and the unfortunate event, and who agreed with the GI’s diagnosis and treatment, you might have trouble convincing a jury.
If your 72 year old client has a permanent colostomy, but is otherwise in good health (except for an understandable depression), don’t ask us to give him/her over $125K per year for the rest of his/her expected life span. Asking for medicals will win points with the jury (assuming we believe there is malpractice), but trying to drastically improve the client’s lifestyle will have a negative effect on our decision, because then it just looks like an extortion attempt.
Given that this blatantly frivolous case made it to trial, I really don’t want to see the quality of the cases that get dismissed.
February 6th, 2006 at 11:46 am
” As I said, there are many studies which show the payout rates based on the missed diagnosis, but I certainly am not going to list my references when I’m arguing with CJD.”
I love this line. It’s like that girlfriend you met at camp who lives too far away to actually come see you right now. Is she doing some modeling, Napoleon?
“I think we need a malpractice court. It might leave a lot of PI attorneys unemployed, but if all they’re doing is filing meritless cases…”
How exactly will a malpractice court eliminate lawyers? Are laymen, who maybe can’t even speak as a result of your negligence, going to present the case to a panel of physicians or judges by themselves? Think critically for a moment about what you’re saying.
What’s funny is that you think that good med mal attorneys will go broke. They won’t, they’ll just not be working for you because the defenes will hire them. Or are you a superhero who can never be injured.
“Multimillion dollar verdicts for everyone are NOT the answer.”
What percentage of verdicts and settlements are multimillions? Do any of the mysterious studies tell you this? Again, think before you type.
“If, like an ER doc, CJD took every case that walked in the door, he’d probably get a lot more respect here (”but I can’t afford that!!” he cries… ah, yes…). ”
You only illustrate your ignorance with posts like this. The ER doc fronts none of his own money to represent the party. He still makes a salary or gets paid through medicaid regardless of the quality of his care in a good percentage of his cases. Your comparison is so inept as to be laughable.
But you’re right, we should get more people’s injuries taken care of. So what’s your proposal? And have you run it by the insurers? Because so far the only proposals out there in the legislatures don’t involve getting more people paid – they just involve insurers paying less.
“They’re huge… billions of dollars if they’re a dime. We order MANY tests, and admit MANY patients to the hospital in attempts to exclude unlikely-but-potentially-ruinous diagnoses, all in an attempt to stay out of the courtroom.”
This claim, like many of your claims, is simply unquantifiable. Why? Because few, if any physicians, will dare take out a bill and say under oath that X,Y, or Z act (that they billed for) was unnecessary. Why? Because it’s insurance fraud. So all we get is their vague assurances of the costs. The actual measurable costs of malpractice against the total health care dollar are around 1-2%. That number IS verifiable.
“and that doesn’t count the ones that are dropped, or settled to make them go away. If one assumes that the courts/juries generally get it right, then the vast majority of malpractice cases are without merit. Those cases suck billions and billions of dollars out of the healthcare system in attorney’s fees, expert witness fees, malpractice premiums…”
You should retake your statistics course, because you are lacking vital ones that would be needed to reach these conclusions. Since you don’t know the number of cases filed (or even claims made without suit) v. how many are tried, you have no idea what the vast majority of cases are. You may be right about the billions, but that’s still a tiny percentage of the cost of healthcare. What’s more, you make another wrong assumption when you say that the attorneys’ fees, expert fees, premiums, would actually go back into healthcare. That’s largely false. They would go into the physicians’, the insurance exec, and the hospital administrator’s pockets.
What’s sad about most physicians in this situation is that while they are chock full of criticisms – about the legal system, healthcare, etc., few have any solutions. The best most can come up with are caps on damages. They aren’t sure what this does other than, if their insurer’s want to, potentially lower premiums and (they hope) make it harder on lawyers.
They also like health courts, but they really don’t know why or how they’d work, or how it would save anyone money or improve healthcare.
What you will never hear is that a study of how to improve the quality of their own services is necessary. It’s never their fault – by and large they are the biggest group of victims you’ll ever meet.
February 6th, 2006 at 11:55 am
I HOPE the system breaks. Lets see what America is like without doctors. Let’s see how many Matt’s out there will be able to continue their parasitism off of the few that can continue to practice medicine.
I have deep loathing for those who would victimize individuals who went into a profession just to help others. I once was one of them.
Now, all I want to do is discourage others from entering into Medicine. It would be in keeping with my hippocratic oath–and preventing suffering–by preventing those poor slobs from going to medical school.
February 6th, 2006 at 12:08 pm
I just hope the frustration and unbelievability of the situation doesn’t die. We have a house supervisor (the one who assigns beds) who is so burnt out she treats this situation as “normal” or “that’s just the way it is.”
If too many give up like that, then we’re lost.
February 6th, 2006 at 12:38 pm
And we love YOU, CuriousJD… without you, we’d forget what PI attorneys are really like.
Your backhanded insults are why nobody is willing to debate you seriously. You make a lot of mendacious comments about how doctors are unwilling to improve the quality of their care, how they’re in a conspiracy of silence, how they don’t really care about people, and how they’re all greedy, etc, etc.
How much of your care is delivered pro-bono, CJD? Give me a percentage, and I’ll give you mine. Do you really want to have an “I care more” measuring contest? I give away plenty of my own services, fully knowing in advance that I won’t get paid… and they get my best effort like any other patient. Do you take pro-bono cases, knowing there is NO CHANCE you’ll get paid? How many times a day do you advocate for a client for free?
You have this funny tendency to claim that unquantifiable expenditures can’t possibly exist. Do you also think that all those unreported rapes we discover by survey data are bullsh*t? I’m telling you we do all kinds of things to avoid your ilk, and I’m the one in a position to know. I don’t expect you to grant the point… it would undermine your position that med-mal is not that big a deal.
Attorney’s fees, expert witness fees, judgements, defensive medicine costs… those sure as hell come OUT of the healthcare dollar… You think all those costs, if erased, would go right back into MY pocket? Yeah… as if that would fly in our current class-envy political climate. Legal costs may not all come out my pocket, but some of it does; thousands per year. Most of it comes out as increased cost for everything else in healthcare. It sounds hollow when you try to make this debate about physician greed, while you conveniently gloss over your own huge financial interest, which I might add, is MUCH larger than mine.
My solution? We’ve gone over it many times on this forum; in a nutshell, a medical court to vet these things for merit before trial. I don’t expect you to support it… too much lost income potential for you.
I love you, man… I really do.
February 6th, 2006 at 2:40 pm
I might add that after facing the jackals it makes me much less fearful to face them and that every physician that is practicing good clinical medicine has little to fear. Even though the cases were frivolous they can’t even choose the best angle of attack because they lack basic understanding of medicine and of cause and effect. Like Matt (CJD), they rant and pontificate but in the end look like fools, but are too blissfully ignorant to realize it, or to see how they have distorted the big picture. So I accept them for what they are, it is just irksome that my costs, my personal time, my time away from other patients, my emotional distress is not worth a nickel, but somehow for a plaintiff client the same things are worth millions.
And as a side point where do they find these so called “expert witnesses”? Where does a washed out doctor with poor interpersonal skills who can’t hack a living anymore in clinical practice send his resume to?
Enough ranting, time to go to work. There are 15 holding admits, 15 in the waiting room. Three nurses “called off” and replacements available. Im glad for my partners that continue to hack it with me.
February 6th, 2006 at 3:51 pm
You guys keep telling yourselves whatever you need to. I personally think we’ll have universal health care within a decade, so all of this will be moot.
And I would almost guarantee that you’ll be longing for these bad old days within a few years of that happening.
February 6th, 2006 at 4:33 pm
Jerry, you are priceless! 15 holding admits, 15 patients waiting in the waiting room, who haven’t even been seen yet, and 3 nurses that called off. Sounds about right that your priority, at this time, would be to jump on the computer for yet one more pissing contest with Matt. Those patients waiting in the “EMERGENCY” waiting room probably appreciate your concern and compassion!
Cathy
February 6th, 2006 at 5:48 pm
Cathy,
You are right. As written it appears pricelessly silly. Failed to mention that I am not scheduled to work today. I happened to be in the hospital for administrative duties and noted what was going on and stepped in to make a dent in the waiting room. And yes, pissing with Matt (CJD) is not particularly constructive, just an occasional 2 minute diversion. I should swear it off and not clutter up Gruntdoc’s weblog whose prose (and others) is much more thoughtful than mine.
The nurses hate it when they are short handed and an extra doc jumps in to make things move, but you might feel better that the waiting room now looks much better. The patients in the corridors waiting for admission beds still languish. Nothing I can do about that. Cheers!
February 6th, 2006 at 5:57 pm
*laughing* Don’t worry, Cathy. I can pretty much guarantee that Jerry is not sitting on his ass, spending his whole shift arguing with CJD while patients are waiting to be seen. That level of neglect on his part would cause his group/partners to invoke his contract’s 60-day-out clause in a heartbeat (I would if I had to carry his slacking/blogging carcass the whole shift.. no offense, Jerry). First things first… and patient care trumps all. Most ER docs have elevated the prioritization of tasks by importance to an art form; you can’t survive in the ER without that ability.
That said, if there are no ER rooms in which to put those patients, no staff to assist him in their care (ER docs are only one small cog in the ER machine), and no beds upstairs to take all those ER holds, there’s not much a doc can do but field patient complaints, and beat his head against the wall. That’s the very situation that started this whole thread (before we all took a detour into malpractice land).
February 6th, 2006 at 6:24 pm
To the other ER docs: Call me crazy, but isn’t arguing with the lawyer sodomites on these sites like a good bottle of Go-Lytely? You come to work, the patients you admitted yesterday are still sitting in the hall, there’s no beds, you’re taking 5 patient expects an hour to put in beds you don’t have, the boss wants to yell at you about that State Senator’s Aunt who didn’t get a bed, you see the mail courier headed at you and pray he’s bringing you that “video” you ordered and not another lawsuit, the drunk in bay 6 just yakked a pint of blood (all over the drunk in bay 5 next to him), the next patient you’re going to see has tombstones on his EKG (And just got brought in from the waiting room after a 4 hour wait). You leave work through the back door, afraid to face the waiting room you’ve left behind. Then you get home and read a lawyer writing about how he’s saving the world by preventing you from committing “murder and negligence” on your patients, and how if it wasn’t for his actions patients would be unsafe in hospitals. I feel like a kid finally getting out to recess by unloading on these CJD’s after what I deal with at work.
February 6th, 2006 at 9:07 pm
I hear you, DS. I suppose it’s my default to assume the best of people until proven otherwise, even for consistent provocateurs like CJD. I’ll learn one of these days…
Anyway, I’ve met docs with what I suspected were marginal skills, and so have you. We really owe it to our patients to police ourselves. The decidedly unsavory alternative is to let the court system (and guys like CJD) do it for us. Not a good idea; they’re not very good at it. Their profit-fueled dragnet nabs far too many competent physicians who did their level best, but simply had a bad outcome.
I like the medical court idea to vet claims… but in addition to the ability to award money, I’d also give that court some additional teeth. I’d include the power to sanction and pull licenses for physicians who exhibit a pattern of egregious incompetence, incompetence with malice, substance abuse, sexual improprieties with patients… whatever. Not everyone will probably agree on that last point, and there would certainly have to be some due process involved, but I think it would be a feasible alternative to the current mess.
February 6th, 2006 at 10:09 pm
New Guy,
From a couple of posts above. You are absolutely right. My group tracks every single thing that can be tracked. pts./hr, acuity/patient, door to doc time, time to disposition, patient satisfaction scores, nurse satisfaction scores, resource utility, procedures/hr., unscheduled returns, %asa given with chest paint, door to cath lab time, antibiotics for pneumonia, etcetera……….. Of course CJD thinks we do none of that.
If you can’t move the patients fast, efficiently, with the correct diagnosis, and with a smile on your face you are out of the group.
In addition, since we are self insured for medical liability we track and moniter and address risk outliers and trends. Of course CJD says we do none of that.
We collect 36% on the dollar. Twenty – twenty five percent are no pay or illegal aliens, which we pay 15-20 dollars per visit for the priviledge of seeing them and taking their risk, for which there is no paymaster in the sky for. Of course CJD says we do none of that.
It is a survive or die existence, Of course CJD says it is not. Your right there are some physicians that don’t measure up. These are usually the ones that don’t know what they don’t know (like CJD). I have seen a couple of these types from my med school class disciplined by the state board over the years.
And yes DS, sometimes it is cathartic to vent. Too bad physcians have run around like stray cats for too long and do share some blame for current state of affairs. I’ll give CJD that.
February 7th, 2006 at 12:15 am
I have another solution, one I’ve gotten alot of flak for on Kevin’s site: I think we, as physicians, need a militant Political Action Committee (PAC). Do you really think Arlen Spector always votes Pro-Lawyer because he believes their side on everything? No, it’s because the ATLA (American Trial Lawyers Association) sponsors his campaign. Same is true for half the politicians in D.C. The AMA is a paralyzed joke. If we could have a strong PAC, that pays off politicians the way the lawyers do, Tort reform could pass on a national level. The hell with “red states” and “blue states” Money talks. They are all “Green states”
February 7th, 2006 at 7:18 am
DS,
You’re right… money talks and always has. Everything else walks.
The problem, as I see it, is that many physicians are simply too busy to do politics, and it doesn’t naturally lend itself to our profession.
Where do lawyers hang out? The courthouse, where they rub elbows with all the other lawyers we elect to public office. I’m not saying lawyers don’t make fine legislators… some do. In fact, they are better at it than physicians; our existance doesn’t really revolve around creating and wielding the law.
Also, (and I’ve said it here before) I don’t belong to ANY of our professional societies, or the AMA. They all have their problems, and I don’t see any of them (with the possible exception of AAEM) that adovcates well for the in-the-trenches average doc.
My other beef is the groups who posture and triangulate on all sorts of only quasi-medical issues: gun control, no-nukes, land-mine bans (I’m an ex-military doc, and ex-LEO, so some of those really stick in my craw.) Those things have nothing, N-O-T-H-I-N-G to do with nuts-and-bolts EM practice, and only serve to create schisms in what could be a much larger membership.
How I long for the day when they’d say “We have no position on that issue, and we don’t plan to take one. We consider those distractions from our primary mission. Thank you.” That’s all they’d have to say, but nooooo….
February 7th, 2006 at 7:23 pm
I know dissenting viewpoints aren’t you guys’ thing, but thought you might want to know what that liberal and trial lawyer backing CATO Institute recently concluded:
http://www.cato.org/pubs/regulation/regv28n3/v28n3-4.pdf
There is a great deal of public debate about potential reforms of the malpractice system. A closer look at available data suggests that some of the rhetoric surrounding this debate may be misleading. First, increases in malpractice payments do not seem to be the driving force behind increases in premiums.
Second, increases in malpractice costs do not seem to affect the overall size of the physician workforce, although they may affect some subsets of the physician population more severely. Furthermore, no research has linked the decline in physician supply to worse health outcomes or reduced patient satisfaction.
Third, we find evidence that the strongest effect of greater malpractice pressure is in increased use of imaging services, with somewhat smaller effects on the use of other discretionary, generally low-risk services such as physician visits and consultations, use of diagnostic tests, and minor procedures. We find little evidence of increased utilization of major surgical procedures.
While our study does not speak directly to the effect of malpractice reforms, it does provide insight into the mechanisms through which those reforms are likely (and unlikely) to operate. Our analysis suggests that state-level tort reform is unlikely to affect the practice of medicine by averting local physician shortages. We also find no relationship between the level of malpractice premiums and the presence of traditional tort reform measures such as damage caps. This evidence does not imply that traditional tort reform measures are ineffective, for they may have reduced the growth of (perhaps unusually high) premiums in the states where they were enacted. However, our results do call into question the view that states with traditional tort reforms have lower levels of premiums or defensive medicine than states that have not implemented such reforms. Last, while increasing malpractice liability pressures do seem to substantially increase
expenditures on diagnostic procedures, we find little evidence that malpractice payments are driving the dramatic increase in overall health care expenditures.
February 7th, 2006 at 8:28 pm
“That’s the very situation that started this whole thread (before we all took a detour into malpractice land).”
You’re right. So the question is – what are you doing about it? And don’t give me the “impotent AMA” line. The AMA got tort reform passed in a number of states, with help from the insurers. So what is it doing for you guys? And if the AMA isn’t doing it, what are you doing for yourselves?
If you don’t have time to do it for yourselves, why aren’t you hiring someone to do it for you? Heck, lobbyists have no loyalty – if you think ATLA’s lobbyists are good, hire them. Physicians have as much disposable income as anyone to donate to political causes.
Oh, and by the way Jerry, speaking of pontificating and ranting about something you know little about, can you tell me what plaintiff has ever won millions on a claim for nothing more than “emotional distress”, as you claim: “my emotional distress is not worth a nickel, but somehow for a plaintiff client the same things are worth millions.”
February 8th, 2006 at 10:09 am
I would just like to say from a “consumer” point of view that one of the problems with lawsuits is ignorance. My husband and I are currently considering suing the hospital that treated my son. Without going to a lawyer, I dont know how Im supposed to know if his injury is a “bad outcome” versus neglect.
His IV infiltrated. The result was a third-degree chemical burn that was approximately 2″x2″x.5″ – a sizable burn on a 3 pound infant. We were told it was “Common.”
The burn took weeks to heal and left him with thick scars on his hand and wrist. It’s possible that the burn affected some of his muscular function but he’s too little to be completely sure.
Is this a regrettable result? Or is this negligence?
The doctors wouldn’t say, and all their answers had a certain quality of carefully-picked words.
If it is a result of negligence, I dont want some extraordinary monetary compensation (or any at all). What I would like is my son’s hand fixed.
The only way I will be able to find out the answer (apparently) is by suing. Once I sue, I really have no choice but to ask for monetary compensation. And a lawyer will get paid.
If there was a medical court it would be so much easier.
My point is that in a sensible world the hospital could say (if it was negligence) that they would repair the damage and use their own staff (who would presumably provide the service at a discount to them)to fix the problem.
My point is – I have no way to tell if this is a mistake or negligence. Reading my son’s chart wouldn’t help me, as I dont know what the reasonable procedures are for preventing IV infiltration and if they were followed.
As far as tests go, I come at it the other way. I get strep throat about 4 times a year (for the past 20 years). I know strep like I know my job and in most cases I get a white-coated throat before I even start to feel the other effects (sore throat, fever). I dont need a strep test. I need antibiotics.
Yet, the one time I went to an ER for strep the doc gave me the antibiotics perscription and insisted on sending out a strep-test, the results of which would not be back before I left the ER.
Crazy.
February 8th, 2006 at 12:58 pm
“My point is that in a sensible world the hospital could say (if it was negligence) that they would repair the damage and use their own staff (who would presumably provide the service at a discount to them)to fix the problem.”
They could do that right now in this world. Settlement offers are not admissable as evidence. They choose the wall of silence.
February 8th, 2006 at 4:27 pm
That girl: write a letter to your doctor and to the hospital President. Outline what happened when, and lay out what you want done. (You may not know, then a request for a paid referral to a pediatric hand specialist would be a good place to start).
I wouldn’t bother with any threatening language, just a formal letter will be enough to get them sweating.
If that oesn’t get your child cared for, then there’s always the CJD option. I’m sorry you haven’t been dealt with in a more straightforward manner, and andmire your restraint for not jumping directly to the ’sue ‘em’ answer.
February 8th, 2006 at 11:34 pm
Please, let us know how it turns out.
Of course, as GruntDoc may not know, most lawyer do send a demand letter before filing, unless they are running up on a statute of limitations. If a case can be settled prior to filing, it’s obviously more beneficial for the patient and the attorney.
February 9th, 2006 at 9:56 am
I just wanted to point out to you that not all patients are money-hungry and sue-happy. Im sure you only see that aspect because there’s no reason for you to talk to patients who might have had a legitimate reason to question the care and chose not to sue/pursue it.
I could tell you stories about er docs that would make you cry. My favorite was one doc who told me (on a Friday night) to just not eat anything until I saw my doctor on Monday. I made him write it on the discharge instructions. That was the sum total of his treatment for which I was expected to pay $350.
I think really good doctors often forget that any population has a percentage of morons for which everyone pays.
But please know that the majority of us understand the work you do is thankless, time-consuming, deals with a very high percentage of patients who got there by doing something moronic(of which I have been one). We very much appreciate the long time you spent in school and how hard you work.
So since we obviously dont say it enough…
Thanks!
February 9th, 2006 at 10:11 am
“Yet, the one time I went to an ER for strep the doc gave me the antibiotics perscription and insisted on sending out a strep-test, the results of which would not be back before I left the ER.
Crazy.”
Theoretically, If he does it that way they should have a “follow-up nurse” who calls you the next day if the strep culture is negative, and tells you to stop taking the antibiotics. Saves you from the problem with resistance. I’m so fed up and burnt out I don’t bother, I just give most patients who want the antibiotics the ABX they want. I’m sure I’m treating alot of viruses with antibiotics, but I’m seeing 5-6 pts an hour these days, I don’t have time to explain why viruses don’t need abx.
February 9th, 2006 at 10:13 am
Oh, and by the way, if you are going to sue anybody for an IV infiltrating, shouldn’t it be the nurses, who are probably the ones who put in the IV in the first place?
February 9th, 2006 at 11:29 am
That Girl,
Thanks for the thanks. I do hope your son has no lasting damage from IV infiltration. What medication infused caused the burn?
Matt (CJD) her point was that she did not want to have to go see a lawyer and therefore there would be no demand letter before filing. And you may not know, but we are told by our insurers and lawyers NOT to correspond with the plaintiff or the plaintiff attorney but instead just give details of the case to our lawyer representative. I didn’t invent the system, that is the way it is, and something that I agree is fundamentaly wrong. Some type of medical legal review board would save a lot of time and frustration in many cases like That Girl. You always ask what is our profession going to do about it. The legal system sets the playing rules so what is your profession going to do about it? Trial lawyers have too much invested interest in keeping things the way they are.
In the demand letters that I have recieved before filing they are so bogus without liability, so on one level why should I respond to demand letter and give some money? My insurer forcefully tells me not to have any correspondence anyway. On another level, perhaps things are just a misunderstanding and the plaintiff would be satisfied if there could be a sit down chat and have a chance to ask questions and have them answered. However, once an attorney is involved on the other side that can’t happen. At least not with my insurer, and that is the only perspective that I can speak from.
And yes, there have been millions awarded for “emotional distress” in court cases. Pain and suffering is limited to 250K in my state in medical malpractice. The other side can still “claim” millions however in the accusations. I never said they would be awarded that.
February 10th, 2006 at 2:31 am
That Girl, I agree with what Gruntdoc said. Letters go a long way if they are sent to the right people. My family took that route after my grandfather was sent home from an ER with three hip fractures, no pain medication, and unable to walk. My family met with the hospital administrators and also sent letters. The administrators, to their credit, (after some prompting from my mom) went to the nursing home where my grandfather was recovering from surgery and apologized to him. It would have been nice if the doctor had apologized, but I guess you can’t have everything.
February 10th, 2006 at 8:07 am
“And yes, there have been millions awarded for “emotional distress” in court cases.”
Name one where millions were awarded for “emotional distress” without physical injury.
“The legal system sets the playing rules so what is your profession going to do about it? Trial lawyers have too much invested interest in keeping things the way they are.”
Yes, it’s all the lawyer’s fault that physicians won’t take the time to sit down with the patients and explain what happen. Is there nothing wrong with the way physicians go about their business? Is there no room for improvement? You guys are almost Bushian in your willingness to blame literally everything wrong on others, and claim that you haven’t made a single mistake.
Didn’t you read her post? She can’t get an answer NOW, and she hasn’t hired a lawyer. And its your insurer who is telling you not to talk to the patient, not their lawyer. Again, settlement offers are not admissable. If you don’t talk to your patient because your insurer tells you not to, that’s no one else’s fault.
February 10th, 2006 at 9:20 am
CJD, are you really a graduate of an accredited law school? I can poke holes in every line of your last statement, but I’m not even going to bother. Just for example line 2 you added your own unattached claim to disprove line 1. Physical Injury? I know we’re Doctors, but we understand logic. You need some work dude.
February 10th, 2006 at 12:20 pm
“Name one where millions were awarded for “emotional distress” without physical injury”
C’mon Matt, even with your last added disclaimer just use google for lots of fun and interesting reading.
“She can’t get an answer NOW, and she hasn’t hired a lawyer.”
A good way NOT to get an answer is to get a lawyer involved, because then any discussion or apology will be construed as an admission of guilt and used against you in the courtroom. Gruntdoc and the previous posters are correct, TRY writing a letter or talking to administration first. You think yourself way too important. Nothing will misconstrue the truth from both sides once lawyers are involved.
In 3 frivolous suits filed against me the first thing I ever heard from the plaintiff was a letter from an attorney. I would be happy to talk with a patient or family but you have to come to me about it. I see 25-30 patients a shift, I don’t follow everyone home or know what happened. Now the decedant in these lawsuits will suffer through years of lawyer agony only to learn that death happens while keeping lawyers employed on both sides wasting money.
“You guys are almost Bushian in your willingness to blame literally everything wrong on others, and claim that you haven’t made a single mistake.”
Huh? I’m no bush fan and disdain politics in general, but what does Bush have to do with it? unless you want to blame him for everything like the liberal left. “Its not my fault” has always been the liberal battlecry.
DS is right, you really have lost all credibility. Find a new pseudonym and start over.
February 10th, 2006 at 3:51 pm
“C’mon Matt, even with your last added disclaimer just use google for lots of fun and interesting reading.”
So I take it you couldn’t cite such a case. I’ll try again. Please list a med mal case where a victim got millions in damage for purely “emotional distress” unaccompanied by physical injury.
“You think yourself way too important. Nothing will misconstrue the truth from both sides once lawyers are involved.”
Actually, I don’t think I’m all that necessary at all. What’s sad is that you think it’s perfectly fine that her own physician won’t even speak to her, and now she should have to write a letter to the administrator. Why would you testifying under oath make the truth misconstrued? Would you lie?
I’m sorry you didn’t get the Bush reference. It’s an analogy, but if you don’t have the context for it, it’s understandable. What’s funny is that if you read your posts, “it’s not my fault” seems to be your company line.
I’m not too worried about the assessment of you and ds on my credibility. You two may be OK physicians, but beyond that your understanding of most other things appears to be painfully lacking.
Watch out for that train!
February 10th, 2006 at 5:00 pm
“So I take it you couldn’t cite such a case. I’ll try again. Please list a med mal case where a victim got millions in damage for purely “emotional distress” unaccompanied by physical injury.”
I won’t waste time looking, but to parce things like a lawyer for you. I never said “got”, I said “claimed”. I never said “without physical injury”, you added that disclaimer as well.
“What’s sad is that you think it’s perfectly fine that her own physician won’t even speak to her.”
This is why you have no credibility as a troller. READ FOR COMPREHENSION (your favorite line). I NEVER said that was ok. Don’t put words in my mouth. That is why I say find a new pseudonym and start over.
Sheesh, this is so childish, but CONGRATULATIONS Gruntdoc, you got 100 comments from your original rant.
February 10th, 2006 at 5:19 pm
“I won’t waste time looking, but to parce things like a lawyer for you. I never said “got”, I said “claimed”. I never said “without physical injury”, you added that disclaimer as well.”
Oh, so what’s important is not the actual result, but the claim. I see. And actually, what you originally asked for was to be compensated for the “emotional stress” of going through trial and implied that people got millions for similar claims. Presumably, that does not include a physical injury. In essence, you were just spouting off nonsense.
” READ FOR COMPREHENSION (your favorite line). I NEVER said that was ok. Don’t put words in my mouth. That is why I say find a new pseudonym and start over.”
I hope you take your own advice because it’s pretty clear you aren’t reading what you write. You’re a nice kid, Jerry, but stay away from the hysterical rantings of the alleged ills of medical malpractice. You’re smarter than that, I’m sure.
What’s amazing about these 100 posts is that, like most of the lobbying efforts and money spent by doctors, it’s about something that will ultimately effect them very little. Meanwhile, the bigger issues cruise right on by.
February 11th, 2006 at 6:22 pm
That Girl, Jerry is absolutely 100% correct about the fact that once attorneys are involved nobody is going to talk to you. The best advice I have is get all your ducks in a row. Get a copy of the medical records, sooner rather than later. Read them closely. Then, go and talk to somebody high up in the administration. We didn’t make an appointment. We showed up at the administrator’s office. He was in a meeting for 2 hours. And we waited for 2 hours. Then we presented the records to him and asked what the hell was going on. We asked, How do you have a physician employed in your hospital who tells a ninety year old man he is going to have to “find a way home,” after he has fractured his hip in 3 places (the radiologist read it the next morning), and then give him no pain medication. My grandfather actually had to call his own ambulance to take him back home, because he couldn’t walk. If you think that administrator wasn’t squirming. He stammered and stuttered. We were pissed. THe hospital will do an investigation, and at least at the hospital my loved one was at we were told we would be notified of the results of that investigation. There’s always the option of suing, but that is a very long arduous process I wouldn’t wish on my worst enemy. If there’s any other route, I would say take that one. If you don’t get the answers from the hospital, then there’s also the option of filing a complaint with the dept of health or the Board, they will do an investigation, also.
February 11th, 2006 at 6:43 pm
I just read DS’s comment about suing the nurse – that’s exactly what I was thinking. I thought IV’s were under the nurse’s domain. Aren’t nurses supposed to be monitoring and watching for infiltration?
February 12th, 2006 at 1:15 am
I’m a patient, but I couldn’t agree with you more. There are many areas in which patients could use more information . . .cost is only one of them.
February 16th, 2006 at 11:42 am
Wow, I thought it was over until I checked back. It probably is the nurse’s fault (if any fault) but I really dont know how it works. That was kind of my point.
Who is responsible?
I dont know, and frankly, Im more interested in fixing the problem rather than blaming someone.
My son was diagnosed with a heart defect that would (in his case) leave very little margin for survival after birth. I read up on everything and came back to the doctor to tell him I had decided to go through with the pregnancy. I had read about many successful treatments and read about many thriving children. He said to me “Of course, you’re not going to hear the unsuccesful stories.”
I took his point, and I was just trying to make the point that doctors never hear about people like me – who dont know (until you guys provided me with several answers) what to do to get an answer out of the hospital staff and are unwilling to sue as a reflex. We exist. Some of us get bad care.
I was only trying to posit to a weary ER doc that there are plenty of us who are unlike the bad people he sees – just as I dont automatically assume that the ER doc Im going to see is stupid/negligent just because one was in the past.
I would LOVE to have a medical review board but practically, for every person like me who may just want “Im sorry I screwed up. Ill be a lot more observant/change my habits so I get more sleep” there is someone who thinks that a reasonable accident should probide them with enough money for life. Or even the understandable if illogical view that someone must be to blame for everything and no margin for error exists anywhere.
Once again, thanks to all the ER docs!
And thanks for the explanation of the test-after-I-leave thing, Good to know. And fyi, i do understand why viruses and antibiotics dont mix I just didnt understand the connection since no one has ever called me to follow up from an ER.