Surveyed Physicians Are Gloomy About Health Care Reform

Patricia Salber

Posted 3/12/12 on The Doctor Weighs In

Recently, The Doctors Company (TDC), the country’s largest insurer of physician and surgeon medical liability, decided to survey doctors to determine what they are thinking and feeling about health reform.  The results are pretty gloomy.

To put this in context, it is important to understand a bit about how TDC conducted the survey.  First of all, the universe of doctors they reached out to were doctors insured by The Doctors Company.  That means large self-insured medical groups, such as those affiliated with Kaiser Permanente, were not included.  Nor were doctors whose insurance was provided by their employers or doctors using other insurance carriers.  This matters because if the TDC insured physicians are not representative of doctors as a whole, the results of this survey would not necessarily reflect the attitudes of all doctors.

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Malpractice Reform: Unfinished Business

Wednesday, July 6, 2011

In this week’s Journal of the American Medical Association, cardiologist Peter Kowey, MD describes a case in which a young athlete sees him for a second opinion after a single episode of presyncope. Despite extensive cardiovascular testing that found no evidence to suggest that this young man had an increased risk of sudden cardiac death, another cardiologist had nonetheless recommended the implantation of a defibrillator. Why the overly aggressive recommendation? Dr. Kowey discovers that his colleague, who had endured a lawsuit about a patient with similar circumstances, was practicing “defensive medicine.” He goes on to observe:

Defensive medicine is pervasive and takes many forms. It extends from ordering too many tests all the way to performing unnecessary surgical procedures. Lung nodules that used to be followed end up in a specimen jar in the pathology laboratory. Subcritical coronary artery lesions are dilated and stented. And the contamination is not just at the individual physician level. Practice guidelines are formulated by colleagues who hear the wolf at the door. In the absence of definitive data, wouldn’t it be logical that recommendations about the frequency of prostate biopsy in patients with abnormal PSAs would be on the more frequent side for safety’s sake? And once those guidelines are published, physicians who ignore them do so at their peril.

Medical Liability Reform Should Be Real and Effective

Victor Schwartz

First published 2/24/11 on Kaiser Health News

In his State of the Union speech last month, President Barack Obama appeared to offer an olive branch to congressional Republicans and those who favor medical liability reform when he said, “I am willing to look at other ideas to bring down costs, including one that Republicans suggested last year – medical malpractice reform to rein in frivolous lawsuits.”

One has to commend the president for addressing the issue, but there are some problems with his statement. To find out why, just look at the Republicans’ principal medical liability legislation, H.R.5, which has been reintroduced this year in the House by Rep. Phil Gingrey, R-Ga. It does not include sanctions against frivolous lawsuits, which often take the form of court-imposed fines or penalties. And with good reason. As every competent medical malpractice plaintiffs’ lawyer knows (and defense lawyers know, too), it is very rare for plaintiffs’ lawyers to bring frivolous medical malpractice suits. The fact is most plaintiffs’ lawyers turn down most medical malpractice suits, for which preparation is cost- and labor-intensive, because they are not viable. (We do need stronger sanctions against frivolous claims, but that is an across-the-board issue. The president should support a separate piece of pending legislation, the Lawsuit Abuse Reduction Act, which accomplishes that important goal.)

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