If you want to get the hair on the necks of an audience full of docs to stand on end at a health reform lecture, utter the words salary or malpractice. Without question, the two most galvanizing issues in our field, they hit hard because we feel their impact both in our professional and personal lives. In addition, the outsized effects med mal has on our psyche cannot be overstated—especially by those whose shoes have never tread hospital ground.
While the literature base estimates the total cost of medical torts on health spending in the low single digits, probably correct, the figures don’t account for sleepless nights and injured amour-propre.
As I perused health related articles the last few weeks, I could not help but notice the number of stories with malpractice mentions. Introduce a new wrinkle in how we supply care, summarize a new regulation, or describe a new delivery intervention, and the specter of getting sued follows. Provision of care and torts have an inextricable link—despite the (benign) inability of the public to make the association.
Again, even though the aggregate effect of med mal consumes a small slice of the health expenditure pie, trust me, it’s on doctors’ minds. A lot.
“Medicine as a team sport” has become a stock phrase nowadays, and you cannot attend any conference with ACO or health home as theme without it permeating the take-home message. The irony however, inhabits the concept of “team.” Last time I checked, the team does not attend the deposition; the team of nurses, pharmacists, and social workers do not reside alongside the physician’s file in the NPDB; and the team does not have their identities published in the papers when cases have unfortunate ends. Click here if you need further assistance.
Back to the articles though, I started compiling a list of excerpts. As my page filled, I realized based on volume alone, I had the makings of a post. Seeing the whole of the journalistic parts makes more of a point than their sum. Take a look:
–[T]hough it is possible that family members may be less likely to sue relatives than are unrelated patients, we are aware of cases in which estranged family members have turned in their physician-relative to the state medical board.
—More than 50% of survey participants cited concerns over malpractice lawsuits as the main reason they ordered tests or procedures that weren’t needed. Another 36% noted that they ordered tests “just to be safe
—Second, institute tort reform to limit unreasonable malpractice lawsuit awards. This would reduce the crushing burden of malpractice insurance on all physicians.
–And to add insult to injury we spend 10 to 15 years learning our trade, get held to impossible standards of perfection, are vulnerable to being sued daily by a corrupt and unregulated legal system, then forced to conform to an electronic billing system that adds hours to our day.
–More medical lawsuits and higher payouts is a budget buster for all of us — it will sharply drive up costs for health consumers and taxpayers, reduce health access across underserved communities, and make it harder for community clinics to keep their doors open and offer vital services to those who need it most,
–[A] desire by doctors and mothers to schedule their deliveries; and fears of malpractice lawsuits should the baby be injured during a normal delivery, which typically takes far longer than a cesarean.
–Doctors are often hesitant to apologize because they are scared of lawsuits.
–If you’re looking at different studies and reports you can find studies that say up to 20 percent of our health care costs is defensive medicine.
–Fear of litigation is the most significant cause of not discussing medical errors.
–The study cautioned that a boost in mid-level providers performing surgical procedures could lead to more cases of malpractice, a concern Coldiron said suggested a need for greater regulatory oversight of nurse practitioners and physician assistants.
–And don’t forget the fear of lawsuits; runaway malpractice-liability premiums;
–These requirements not only necessitate the hiring and training of additional employees, but also expose me to legal liability.
–The amount of pressure and risk that you take seeing patients for eight to 10 minutes per session, the educational debt, the fear of getting sued, all of that has created a climate of dissatisfaction.
–Show me a primary-care doctor who would argue with a lawyer-doctor who has determined that his child should have a CT scan.
–We try our best to keep the patient’s best interests in mind, but after we’ve fought and fought, sometimes we give in, tired out and afraid of being sued.
–“In medicine, malpractice isn’t something we just think about when a patient dies. Malpractice is always in the back of your mind.”
If you think I stopped here because I ran out of links, think again. I could catalog a second page, but I believe you get the point, plus, you don’t need the Prozac.
I also wanted to embed some authoritative figures below to provide some grist for part II, as well as place the above quotes in context:
Figure 1: “Sucks to be a neurosurgeon:”
FIgure 2: “Still Sucks to be a neurosurgeon:”
FIgure 3: “Still want to go into neurosurgery?”
In part II, I will introduce you to someone who can shed some light on my original question in the header. I will serve the entree next week, so stay tuned. I hope you enjoyed the amuse bouche.
UPDATE: Talk about timely. Out today in NEJM: The Effect of Malpractice Reform on Emergency Department Care
Bradley Flansbaum, DO, MPH, MHM works for Geisinger Health System in Danville, PA in both the divisions of hospital medicine and population health. He began working as a hospitalist in 1996, at the inception of the hospital medicine movement. He is a founding member of the Society of Hospital Medicine and served as a board member and officer. He speaks nationally in promoting hospital medicine and has presented at many statewide meetings and conferences. He is also actively involved in house staff education.
Currently, he serves on the SHM Public Policy Committee and has an interest in payment policy, healthcare market competition, health disparities, cost-effectiveness analysis, and pain and palliative care. He is SHM’s delegate for the AMA House of Delegates.
Dr. Flansbaum received his undergraduate degree from Union College in Schenectady, NY and attended medical school at the New York College of Osteopathic Medicine. He completed his residency and chief residency in Internal Medicine at Long Island Jewish Medical Center in New York. He received his M.P.H. in Health Policy and Management at Columbia University.
He is a political junky, and loves to cook, stay fit, read non-fiction, listen to many genres of music, and is a resident of Danville, PA.