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June 14, 2004

Comments

Well, you're right Edward, of course, but this sort of nonsense is of a piece with Catholic bishops' recent statements.

War is being declared on American soil against all to the left of center who disagree with the far right. Lines are being drawn around certain groups for future action of some kind.

I always like to get a head start on paranoia.

Lawyers don't sue doctors, patients do.

Well done, Edward! Excellent reversal of argument.

The reality of the situation is, though, that some lawyers do openly troll for lawsuit-fodder. Here in sunny Florida, they used to advertise relentlessly on television and radio until the state passed legislation to make them stop. Which they did, only to replace the ads for service with so-called public service ads.

If the lawyers are only doing this as a service, then they should have no problem cutting out the percentage-of-the-take fees. And this isn't the first time and place this sort of thing has been done. Or maybe they can keep the percentage fees in exchange for paying court costs and legal fees for those they sue unsuccessfully. Right now, for the doctors it's no-win, and for the PI attorneys it's no-lose.

I know they're hyper-agressive, Slarti, but ambulance-chasers trolling for business only get it if patients give it to them.

As you note, it's a no-lose for the attorneys, so unless the patients do something to change the situation, it ain't gonna change. Aren't there caps, per state, for lawyers? If there were fewer of them, they'd be less likely to have to encourage unnecessary suits, no?

It can be a "no-win" situation for the PI lawyers if they don't win; most cases are taken on a 'no award, no fee' basis. And the clients are perfectly within their rights to negotiate the percentage of award due the law firm.

But this entire malpractice insurance issue is a red herring. Malpractice litigation's contribution to healthcare inflation has remained pretty constant for the past three decades.

Dr. Hawk's pique is misplaced; if he insists on denying medical care to those responsible for rising insurance premiums--he should refuse to treat insurance agents.

Jadegold took the words right out of my mouth, uh, keyboard. Malpractice payouts are a red herring. They account for less than 2% of total health care costs. Physician fees and hospital charges (large fees) account for more than 60%. But there's a further reason that this issue is a red herring. The practice of medicine is theoretically self-policing. And it's pretty well-documented that a handful of doctors constitutes a substantial part of the real problem. The problem can be corrected any time medical doctors decide to correct it.

The problem can be corrected any time medical doctors decide to correct it.

What would that take? Taking away the license of anyone who gets sued? Or just those who are found guilty of malpractice? Who would review whether the verdict was accurate? etc. etc.

What would it take? It would a willingness for doctors to sanction their peers who are sued for malpractice at rates that far exceed the norm based on specialty and patient load.

Doctors don't want to talk about bad doctors, over which they should have some control, they want to talk about bad lawyers, over which they have none.

Not to mention that malpractice "reform" has failed to lower malpractice insurance rates in any jurisdiction in the US. As Jadegold said, look at the insurance companies for this problem, not the lawyers.

Something akin to legal disbarment might do the trick.

Hmmm...more anti-doctor sentiment here than I expected. Interesting.

Why not a three-prong approach: Doctors, lawyers and patients all owning their part of this to find a solution?

It's clearly in the self-interest of the doctors and patients (lower healthcare, no?), so a motivating factor for lawyers would be a good way to bring them to the table (Slarti's idea of "exchange for paying court costs and legal fees for those they sue unsuccessfully" or something like that).

The quacks, the malingerers/frauds, and the ambulance-chasers all own a part of this...representatiaves of each should be brought to the table and encouraged to find solutions.

What would that take?

Yes, some docs should lose their licenses.

I'm talking about before cases gets into court. Every doctor with whom I've actually been friends has known of physicians who give unacceptable levels of care—they've told me as much. Every nurse and receptionist does, too, but their opinions don't have as much weight (nor should they be taken as seriously). And physicians are ethically required to deal with such practitioners but are, understandably, reluctant to do so. Were such practitioners to lose their licenses the problems of the others would be reduced. The problem of lack of national and international systems to track such things is a separate problem.

There are two kinds of medical malpractice cases: bad doctors who have been caught and frivolous suits. Not all medical malpractice suits are frivolous and, IMO, most cases of medical malpractice are never found out.

Edward:

Why not a three-prong approach: Doctors, lawyers and patients all owning their part of this to find a solution?

I couldn't agree with this more.

"Malpractice payouts are a red herring. They account for less than 2% of total health care costs."

Well you are half right. Payouts (for settlements and adverse verdicts) have grown fairly slowly, while the costs to defend suits (like when you didn't really commit malpractice) have skyrocketed. Unfortunately both costs come out of malpractice coverage.

There's also the cost of "defensive medicine" -- tests and procedures that are done not because doctors think they're particularly necessary but because in case of a lawsuit they want to be seen as having done everything possible, no matter the cost. But I have no idea what percentage of health care costs this represents.

Dave... I disagree with this comment:

"Every nurse and receptionist does, too, but their opinions don't have as much weight (nor should they be taken as seriously)."

Au contraire, Dave. A nurse's opinion should be taken very seriously. Take it from someone in the business: the quality of care one receives in a hospital is a far greater function of the nursing staff than the medical staff.

"nursing staff" and "medical staff" are disjoint?

"Medical staff" generally refers to docs, PA's, etc.

"Nursing staff" refers to RN's, LPN's, aides and techs.

I know it's confusing, but hey- I didn't invent the system. I just work in it... :)

Well, that's no fun. I can hardly ridicule you for something you didn't invent, now, can I?

"If the lawyers are only doing this as a service, then they should have no problem cutting out the percentage-of-the-take fees."

Interesting. What other endeavors would you advocate this philosophy for, Slarti? I'm also not clear: should this be done as a matter of law, or by public shaming?

Are there other endeavors in life in which profit should be limited for public purposes? Insurance companies? Hospitals? Passing an IPO? Or just practicing law?

It was a frivolous suggestion, Gary. But next time a doctor saves your life, don't wince if he charges you 50%.

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