A voice for progressive medicine

April 24, 2012Carole No Comments »

Ever wonder what your physician is thinking? Well, in lieu of truth serum or ESP, you might find some answers at Kevin MD.com, a social media medical blog. The physician viewpoints expressed through his blog are especially timely because health care in the US is such a hot political topic. This aggregate medical blog, created by Kevin Pho, MD, is a combination of his own posts as well as guest posts from physician (and other health care providers) to voice their opinion and insights from their daily work in various fields and at various stages of their career.

Although, the topic  on Kevin, MD is rarely ART, I still find it very interesting, because of the insights it provides regarding physician opinions about the current health care system. Trained as a scientist and not a health care provider,  I have always been interested in how different people handle the (at least to me) awesome responsibility of treating sick and or hurting people. Even as a behind-the-scenes lab person, I felt the responsibility of every patient’s positive outcome resting often too heavily on my shoulders. Intellectually, you know that you can’t make it turn out positive for every patient, but you feel the failure personally when they don’t get pregnant. This perspective makes me particularly thankful for the very good physicians out there who handle this responsibility with grace and kindness and also conversely dismayed by other physicians who take this responsibility lightly or even worse abuse the responsibility our society (and the medical board) has given them.

On the Kevin.MD stage, you generally get a more progressive vision from the often, but not always, younger physicians who are more open to the concept of sharing health care decisions with their patients and who have not yet lost their enthusiasm for patient-centered (or partnered) care. For instance, here’s an intriguing post, “Is patient-centered care an out-moded concept?”  by Dr. Kevin Bear in which he praises the activist patient who is interested in being involved as a partner in their own care. Or as one commenter on the post said, “patients do not want to be in the driver’s seat…but neither do they want to be in back seat…or waiting for a bus!”

Other posts provide insights regarding hot button topics, such as tort reform.  For instance,  “Patients deserve a medical malpractice early offer”, written by Kevin Pho  supports  legislation to require “early offer ” malpractice compensation as a means of tort reform. The current malpractice system serves no one really well, not even the patient. A study published in the New England Journal Of Medicine in May 2006 (volume  354, pages 2024-2033) reviewed almost 1500 closed medical practice claims from five malpractice insurance companies from all over the US. Interestingly, only 56% of the claims received compensation, with the majority of the cases reviewed (85%) settled out of court. In fact, of cases that went to trial, only 21% resulted in the patients being awarded damages. The average financial award was $485,348 (median $206,400). As you might expect, the overhead costs for prevailing in court were much higher (on average $52,000) compared to settling out of court. The average length of time to settle the claim was 5 years.

The claims were also evaluated by physicians to determine whether the claims were medically valid in that medical errors were demonstrated or alternatively, if the claims were without merit. In their estimation, 73% of the claims were correctly decided. Of the remaining claims in which compensation and merit were discordant, errors were of three types. Patients received payment without evidence of documented injury in only 0.4% of all claims and payment in the absence of error was made in only 10% of the claims. In contrast, patients failed to receive any compensation even in the presence of error in 16% of the cases. So, bottom line, although the process got it right 3 out of 4 times, when it failed, patients who should have received compensation were not paid more often than those who shouldn’t have received compensation were paid. So patients really aren’t bringing many frivolous suits nor are they using the legal system as a cash cow.

One alternative to the slow and sometimes faulty current system for compensating patients for medical errors and harm is to offer patients an “early offer”  settlement out of court. These “early offer” financial compensation plans have been criticized by opponents as too low. In the case of Senate Bill 406, the highest possible award would be $117,4500 for major injury or death, less than half of what the average successful claim received in the New England Journal of Medicine study. But patients would receive that settlement within 90 days of the injury, instead of five years. Opponents of the measure also argue that patients who reject the early offer would face a higher standard of proof to prove their lawsuit in court. Interestingly, many states already limit the extent of allowable compensation. In Indiana, the ceiling was $250,000 that could be paid out per claim from the State insurance pool.

I believe that the current malpractice determination and compensation system is deeply flawed and creates a counterproductive adversarial relationship between physician and patient. Patients often feel they have no recourse but to sue when errors occur. Part of the problem is that some patients need to believe that their doctors are superpowers who can fix everything that ails them. Some docs do little to re-size this God-like impression. Setting expectations too high results in a great fall (and sometimes extreme patient anger) when physicians show that they are human too.

Both patients and doctors have to change their assumptions to create a more functional physician patient relationship. Patients have to recognize that their doctor is at best, an imperfect partner in their healthcare. Their doctor, no matter how smart or experienced won’t get it right every single time and will always need the patient’s cooperation, full involvement and honest communication to optimize treatment.  Doctors need to be more open to patient input and involvement in their care. The paternalistic “Doctor knows best” attitude no longer serves physician’s purposes either when almost every patient has access to medical information on the internet and wants to discuss this information with their doctor. Telling patients to avoid the internet just makes patients suspicious of their doctors, not the internet.

If expectations are right sized, there will be more tolerance by patients of human error on the part of physicians. When doctors make non-malicious mistakes, they need to be able to learn from the experience and move on without being crippled by a punitive process. Along with that forgiveness for human error,  there should be no mercy for doctors who prey on their patients or put profit ahead of patient safety. My hope is that physicians will police their own more effectively and develop more robust and effective systems for physician review and correction instead of ignoring or worse protecting colleagues who make mistakes with alarming frequency or callous disregard.

In the end, the daily human interactions between doctor and patient (or patient and everyone else) have a healing power of their own. I think you’ll enjoy this little story of the power of human kindness , The healing power of ice cream. Enjoy.






© 2012, Carole. All rights reserved.

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