More Med Mal Sustenance

By  |  December 14, 2015 | 


I call med mal the joy that keeps on giving.  It’s blogger’s crack.  We all love med mal goodness.

Medscape released their 2015 Malpractice Report–and as always, the results provide some interesting grist for the mill.  I will not go through all the findings, but below, I cite some of the more prominent questions and responses (with my comments).

The usual cautions apply, i.e., the survey uses a convenience sample, and one can only assume Medscape subscribers bring their own biases.  Political leanings and other ideological issues would influence the results I am sure, but we have no way of knowing given the data provided. However, a sample of four thousand with a representative geographic, practice and age mix attaches enough credibility to make the survey noteworthy.  More men than woman did participate, however (70%/30%).

Here we go:








This is a good start.  A third of doctors “truly hate” plaintiffs lawyers.  That’s a firm foundation to begin an interactive dialog with the goal of compromise and love.












Solid.  Nice to know docs see Choosing Wisely more as a sword to inflict carnage upon us than a protective shield.  Someone needs to tell the ABIM Foundation to adjust their messaging campaign.











So much for disclosure and sympathy.  Looks like physicians find the whole notion of enterprise liability and “we got your back” as reliable as the phone support from their local cable network operator.












I will grant you; most provider actions do not get to court.  Further, verdicts tilt in favor of the physician when they do proceed.  But for half of docs to see no room for improvement in their charting or patient communication?  Introspection or self-reflection, anyone?












Okay, you either see the glass as half-empty or full here.  Three-quarters or so of us reside behind the white iron curtain.  We toil in the trenches.  We know the tough decisions all of us must make, day in, day out.  We got each other’s back, yes?  Well, maybe not.  You know on day one of college organic chemistry class when your Prof. says look left and right because one of you will not be here in a year.  Well, I want to find those students who accidentally slipped through, because they are now oncologists…and infidels.  No Obamacare for you!

Take a look for yourself.   The rest is here.   And stop snickering.


To move on, I do want to comment on something deserving of mention and weightier.  I always enjoy American Enterprise Institute (AEI) forums.  They play their panels straight and usually bring in a balanced assortment of discussants.

Some AEI scholars and conservative thinkers just released a comprehensive proposal detailing an agenda for healthcare reform, post-ACA.  It has valuable ideas, and medical malpractice gets a notice. However, I don’t raise the report to criticize the panels’ work.  I raise the report because the plenary speaker at the release, Rep. Tom Price (R-Ga), had some interesting things to say on the subject. The sequence begins with the click:


Keep in mind, Rep. Price practiced orthopedic surgery for twenty years.  He chairs the influential House Committee on the Budget, sits on Ways and Means, and has released a healthcare proposal, HR 2300, to replace the ACA.  He plays a significant role in steering conservative healthcare policy views. I see him at every AMA meeting, and to his credit, avails himself to all and roams the halls like any other attendee.

Given his bona fides, I expect him then to stick to the facts and avoid untruths.  Defensive medicine contributes to excess practice costs and plays a HUGE role in the minds of physicians.  We cannot easily monetize the burdens we all feel after each difficult clinical decision we engage in.  They weigh on our psyche and often make us cynical of our practice environments (and contribute to burnout).

However, regarding direct costs to the healthcare system, a majority of economists (and the Congressional Budget Office) would describe “hundreds of billions of dollars” or “$400-$600B/yr” as fancy.  Moreover, as the primary cause for the same excess growth, no knowledgeable health scholar would agree.  If you need proof, watch the AEI program from the week before on the very subject. Rethinking the storyline for defensive medicine and medical liability: Causes, effects, and remedies.  We have a lot to learn about the root causes of why doctors practice they way we do, and it’s not all about the fear of litigation, just a share among many.

I am not raising the breach to incite partisan bickering.  Nor am I suggesting Price’s comments have anything to do with the AEI release.  I am implying, however, that now more than ever, regardless of ideology, individuals need to adhere to best evidence so constituents, including providers, will not misconstrue genuine efforts to promote compromise.  Price has a commanding position and needs to set an example as a physician leader.  I would say the same for any politician with his credentials, regardless of party affiliation.  I would allude to attacking insurance and pharma companies and hanging full responsibility for system costs on their backs; the ACA as the primary cause of healthcare cost growth reduction, and single-payer as the cure for our countries ills as good examples of how others, perhaps not so close with Rep. Price, play loose with the facts.

Researching medical malpractice will take time.  We have a limited data set and misconceptions about motives and solutions abound. Recycling tired memes will gin up the same finger pointing and prevent vested individuals from providing the education all sides must employ and absorb to find a med mal fix.   We need constructive messages from our elected officials.  End of story.


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About the Author: Bradley Flansbaum

Bradley Flansbaum
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.


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