No matter how much you and the PaMS might try to remove the problem of litigation abuse from the discussion, it is very much an integral part of the problem with present-day health care crisis. And unless Mr. Daschle and Mr. Obama have the courage to stand up to their trial lawyer friends/contributors, there will only be sham reform. BTW, the only outcome I see from Act 13 is for us to provide evidence of extra “patient safety” CME credits every 2 years. This is the classic example of sham reform, because such “reform” only satisfies regulatory requirements, but does nothing to influence actual risk reduction or litigation in clinical practice. Unless one understands that risky practices and errors account for only a minority of law suits, policy makers will continue to tow this misguided line of argument. The potential fear of litigation is what drives practice of ‘defensive medicine”.

It is easy for someone from the board of the PaMS to say “its going to take some time for Philly to improve”. But the situation is so grave that the city may not have that luxury of time. Incidentally, the impact of institutions like Drexel and Einstein on the care in the communities is so negligible that their efforts will have very minimal impact on community practice. Again, I’d like to emphasize my point that any reform efforts must come from the community and its physicians, not from the government or medical societies, if there has be any impact for the average population. Let’s see if the new administration has the guts to consider this avenue for reform

So, while I understand that there is a black hole of medical liability in Philly, the rule changes enacted by our state Supreme Court on venue changes and Act 13 requiring disclosure of adverse events and the patient safety movement ( the 1 million then 5 million lives campaigns) and the growth of ADR (University of Pittsburgh, Einstein, Drexel are leading the way) have all made for improvements in the liability climate in PA. Philly was so bad, it may take a while to see major improvements there, but unless we screw it up somehow, it will come. As an aside, while “tort reform” -as typically constructed – would be nice, I am personally convinced that we are fixing this without tort reform and will continue to do so.

But this is really off topic, as far as I am concerned, as it does not materially effect the larger debate on healthcare reform.

Cheers,

However, I must take exception to his idea that state medical societies are a source of remedy to the medical litigation problem or patient safety, quite the contrary, at least in my state of PA. I have been in practice for 14 years, in three different states. Our practice has actually implemented several patient safety measures and has been presented as a model in the latest educational DVD released by the ACP, documenting our use of advanced IT in delivering care in realtime and achieving patient satisfaction in a small practice setting. In fact, my liability carrier has given me a small discount on the premium due to our risk reduction techniques. Yet the premiums are far too high for my type of practice. I am not sure which state Mr. Hughes practices, but the liability insurance situation has not improved one bit in our state. Clearly his state must be one of those that has taken serious action on tort reform.

One need not look any further than the status of Obstetric services in the city of Philadelphia to realise the devastation caused by rampant misuse of the tort system. For those unfamiliar with the situation, there are no Labor & Delivery services in the city apart from those at the 4 main university centers! So, for the expectant mothers of Philly, they have drive to neighboring counties to have their babies. So, I don’t need someone else to tell me that access to care (and we are talking any type of care) is not compromised due to the litigation issue. And, everyone should stop using the term “med-mal” as though every law suit is a result of malpractice.

Possibly, coming out of “organised medicine” and into the community will provide a more realistic picture for Dr. Hughes so that he can truly understand the extent of “defensive medicine” being practiced. No wonder less than half the practicing physicians don’t belong to their local or national medical societies. We certainly can hope that Mr. Daschle’s team will bypass the big wigs at the medical societies and talk directly to community physicians and their patients, so as to achieve more comprehensive reform.

So where to go with this? More of the same, rearranging the deck chairs on our healthcare non-system Titanic? I hope not! Can we not agree on this: At the very least, an acceptable solution mandates a Social Health Insurance type model. that covers everyone and is NOT tied to employment? I think single payer still makes the most sense, but I am flexible enough not to be married to that as the only solution.

So as not to be too conciliatory, however, let me disagree with the comments about medmal. I don’t think the rest of us are as concerned as he/she is. It is already improving as I discussed earlier. As to my naivete, I’ve been in practice 20 years, been sued 3 times, am on the Board of my state medical society and chair of its patient safety committee, and have completed Federal Mediation Training as part of my committment to ADR.

Cheers,
http://cmhmd.blogspot.com

1) Coverage does not necessarily mean access to care because of two main reasons-very poor reimbursement levels and insurmountable hastle factors (see the article on Medicaid).
2) I totally agree that the main organisation that claims to represent physicians has not been very helpful in promoting reform. This is exactly why policy makers should engage community physicians directly, and not through “organised medicine” channels.
3) The notion of “medical liability canard” is one possibly coming from a naive individual. It is very obvious that medical litigation for the most part is unrelated to “errors” and further that it is usually the process of defending oneself that bankrupts most small practices, not the outcome of litigation. Any policymaker that does not address this problem adequately will not have the full cooperation of physicians and other clinicians, and hence will be unable to institute “reform” in the true sense.

2. I agree insurance should be uncoupled from employment. this is an accident of history and should be remedied.

3. I don’t feel marginalized by Daschle, but often, when organized medicine presumes to speak for all physicians in a belligerent tone, then I feel marginalized by my own professional organizations. So while we should be the backbone of any reform, up until this year, we have been only obstructionist, so I can understand others reluctance to engage us.

4. It’s time to let go of the medical liability canard. It is actually getting significantly better. It’s getting better because of error disclosure laws, alternative dispute resolution and the patient safety movement in general. If you can defend your practice, you do not need to practice defensive medicine.

5. Moral hazard does not apply to most health care decisions. The free market has given us the system we have.

If the plan that emerges out of this debate is similar to the 93 plan, then truly we are a nation of fools.

Cheers,