Paranoia

Dr. Arthur M. Feldman wrote an excellent article in the "Outlook" section of The Washington Post today entitled "10 Things I Hate About Health Care Reform." It was well thought out and clearly written.

His section on tort reform, however, I felt missed two important points on the amount lawsuits add to the overall cost of health care.

He correctly mentions the cost of defensive medicine. A survey published in NEJM last year showed that in Massachusetts, 23% of tests ordered by doctors were done not because the MD or DO thought they were necesary, but because they wanted to have all the ammo they could of they got sued.

He mentions the phenomenon of physicans moving to states that already have caps on pain and suffering awards leaving some states over doctored and some under doctored.

But there are two other aspects of tort reform that need to be empahsized:

1) Insurance companies make more and more money every time malpractice premiums go up. Im Massachusetts, an Obstetrician or Neurosurgeon's YEARLY malpractice premium starts at around $250,000.00. So you have to make a quarter of a million just to open the doors. Then you can start paying the office overhead. So, insurance compaines being the ones that run health care, both private and public, have zero incentive to back tort reform.

2) Without retreat into self-pity,it can be said honestly that being a physician is Very Hard Work. It requires the nicest sense of judgement applied to a vast storehouse of knowledge tempered by the experiencce to know when to inervene and when to refrain. The intrinsic drive to do it well is its only safeguard against mediocrity.

If you apply the above standard every day of your working life while knowing that a lawyer seeking only money, not justice, can drag you into court and paint you as a negligent uncaring bastard, it dulls your edge. More burnout. More defensive medicine.

As a doctor you have to document (in an easily readible form, usually with words of no more that two syllables)to multiple unconnected federal agencies that you are meeting the standards of 'good medicine' established by bean counting bureaucrats.

Then, on top of this, some jamoke who solicits people to file lawsuits via ads on TV, municipal busses and phone books can take over your life for years while a frivilous suit is adjudicated. In most cases, this means that motions (read: billable hours)fly back and forth until the su-er decides his input in work is liable to exceed the probable award, or the su-ee decides that the suit lacks merit, but they've already spent, say 80 grand, to defend against a probable 70 grand award: the 'suit' is settled.

As long as there is a system in place that allows insurance companies to make huge amounts of money on malpractice insurance and provides lawyers the opportunity to tap into that huge pile of cash (both prosecution and defense), there will be no tort reform.

So: Outlaw advertising by lawyers. As lawyers make the laws, this may not happen.

But if a judge were able to lable a suit as fivolous, and force the prosecution to pay the defense's costs, the phone book guys would be much more circumspect about filing suits. And the amount of energy a physician now spends on paranoia (and the defensive medicine costs it generates) could be put back into looking after the best interests of their patients.

The best doctors have medicine as a vocation, not a job. Let's try to get our legal colleagues up to the same standard.