Posted by Guest (Post 209413)

Couldn't agree more. It simply becomes a theatrical contest between sides, and the attitude in today's society is "somebodies gonna pay" regardless of whether any real malpractice occured or not. Whoever puts on the best show wins.
Lawyers know this and manipulate the system, even making good living on lawsuits without merit, because the insurance companies and the lawyers all know it is cheaper to give up a settlement than to fight in court. It is a sickening game in a perverted system and there is no end in sight. Without meaningful change there is no hope of improving the healthcare system.

Posted by Guest (Post 209366)

Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.

The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.

As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.

It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.

As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.

Posted by Guest (Post 209366)

Were this not so far off base I would try to find logic in it. Physicians give away more care than you could ever imagine, and on many different levels. I have been in private practice, , and now work strictly in the in-patient setting. Both private physicians and hospitals give away millions of dollars in care each year. It is by and large why many physicians are abandonding private practice and becoming employees. There can be no meaningful comparison with the pittance of pro-bono work done by most attorneys. Physicians cannot just do 350 dollars worth of work and walk away. A relationship with ongoing pathology requiring treatment has already been placed in motion. I know of NO physician that I am associated with that does not give away care,time and effort, regardless of specialty.

The malpractice issue is deeper than most will ever realize, having a logrythmic ripple effect that is astounding. Some of my colleagues and I sat just last week and figured conservatively that we waste in excess of 1 million dollars a year in tests and procedures based almost soley on malpractice concerns. Multiply that by tens of thousands of physicians and you start to get a small inkling of the problem. To infer that physicians are the primary cause of the malparactice issue is really obscene. Anyone with even a modicum of experience in this arena knows without a doubt that the legal lottery system in place and the lawyers with little or no scruples that abuse it are by FAR the driving force. It is completly ridiculous and has been for years.

As far as emergency care being available to anyone..this is true. It is also the most ineffecient and dangerous way to attempt to provide ongoing care for anyone. People that are without the means to obtain maintainance care are infinitiely sicker when they do show up at the E.R. and require vastly more resources that if they had simply had maintainace care for their diabetes, hypertension, asthma, heart disease, etc. etc etc.

It seems painfully obvious that most of the people saying that the staus quo is fine are those with good ways of funding their healthcare.

As far as rationing of healthcare goes it is done now based on profits and has been for years. Just because you may have been insulated from it does not negate the truth..that it is happening. Unfortunately there does need to be oversight on some care. Estimates that up to 30% of all medicare dollars are spent in the last year of life..with NO improvement in life expectancy or quality outcomes are important to note. We use a lot of resources flogging patients with high tech "life support", feeding tubes, multiple surgeries, all the while knowin that there will be no appreciable change in outcome. We should have evidence based guidlines on what is appropriate, and education of patients and families. Will every patient fit the "mold"? no. As a safegaurd there should be a stop button by the primary physician involved in care or other safegaurd measures. If you want to "live" at all costs be prepared to pay the price, and also offer parity to those less fortunate. Just remember at the end of the day we are using resources to do things that won't help, and often prolong suffering of people with advanced illness, age, and terminal conditions. Sometime living at all costs is not really living.
The fact is, if you have not been without health care in a time of need, or if you are not a provider of healthcare in today's environment you really should try to absorb and learn before making blanket pronouncments.
At the end of the day, we spend more per capita on healthcare than any country in the world and as a whole don't get any better than a mediocre return as assessed by international standards. It past time for change. It will not be perfect, will not make everyone happy, will not be a panacea, but we must adapt and improve the system. For those of you happy with it as it is, may God continue to bless you with the means to maintain your healthcare, for the rest of the country we will need to carefully figure out something different.

Posted by Guest (Post 209434)

The point about pro bono services is that for some it is mandatory, while others it is totally optional.

I've met a lot of physicians who blame everything on the lawyers and ingrate patients and see themselves as totally innocent in everything related to the health care cost issue. However, physicians did indeed set themselves up for the lion's share of the problem.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

There's an old commercial litigator's saying that the best kind of person to sue is a physician or car dealer. Juries hate both, and almost everyone in the jury has had a bad experience with both. There is very little sympathy or empathy anymore for the physician by jury members, and most have considerable empathy with the person suing. Why is that? Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Everything would point to physicians being able to have their customers as adoring supporters, yet the reverse is usually the case.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

So, when "tort reform" is thrown around as the cure-all to the health care situation, the underlying cause of medical malpractice cases - lousy physician-customer relationship - will still exist. And since medical malpractice cases are heard in state courts, "tort reform" is a state matter, not fed.

So, try to remember the time when there wasn't a plethora of medical malpractice suits and ask, "what has changed?" When that question is answered, then the situation can be corrected so that the lawsuits diminish. But that will take a reform of health care delivery which recognizes patients as humans first and accounts-receivable second to be successful. The physician can indeed "heal thyself."

Please note, I have great respect for the medical profession and those dedicated to it. I do hope that someday the medical profession will learn what other professions have discovered - treat the customer with dignity and respect, and invest the time to know the person as more than an account number, then you have a loyal customer AND friend who will give you every benefit of the doubt in every circumstance. There is a "cost" to adjusting your business to this level of customer relationship, but it's worth it in the end.

Growing up in inner-city Boston, I can still remember "Dr. Bill" who came to the house, had coffee at the table before continuing to the next house, and thought of as a decent guy who "watched your back." Welby did exist....

Posted by Guest (Post 209434)

The point about pro bono services is that for some it is mandatory, while others it is totally optional.

I've met a lot of physicians who blame everything on the lawyers and ingrate patients and see themselves as totally innocent in everything related to the health care cost issue. However, physicians did indeed set themselves up for the lion's share of the problem.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

There's an old commercial litigator's saying that the best kind of person to sue is a physician or car dealer. Juries hate both, and almost everyone in the jury has had a bad experience with both. There is very little sympathy or empathy anymore for the physician by jury members, and most have considerable empathy with the person suing. Why is that? Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Everything would point to physicians being able to have their customers as adoring supporters, yet the reverse is usually the case.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

So, when "tort reform" is thrown around as the cure-all to the health care situation, the underlying cause of medical malpractice cases - lousy physician-customer relationship - will still exist. And since medical malpractice cases are heard in state courts, "tort reform" is a state matter, not fed.

So, try to remember the time when there wasn't a plethora of medical malpractice suits and ask, "what has changed?" When that question is answered, then the situation can be corrected so that the lawsuits diminish. But that will take a reform of health care delivery which recognizes patients as humans first and accounts-receivable second to be successful. The physician can indeed "heal thyself."

Please note, I have great respect for the medical profession and those dedicated to it. I do hope that someday the medical profession will learn what other professions have discovered - treat the customer with dignity and respect, and invest the time to know the person as more than an account number, then you have a loyal customer AND friend who will give you every benefit of the doubt in every circumstance. There is a "cost" to adjusting your business to this level of customer relationship, but it's worth it in the end.

Growing up in inner-city Boston, I can still remember "Dr. Bill" who came to the house, had coffee at the table before continuing to the next house, and thought of as a decent guy who "watched your back." Welby did exist....

Posted by Guest (Post 209436)

Sorry, when it comes to who "jurys hate most".... the lawyers are in good company. See attached.

http://www.times-standard.com/davestancliff/ci_11971293

Posted by Guest (Post 209441)

Simply put you are wrong, and with all due respect out of touch with the subject as it exists in todays world.

If you want to use the courtroom as the example of what's wrong, let's look at the participants. Everyone in the courtroom that matters - judge and jury members alike - in the last couple of generations has sat sick or hurt in a physician's office, waiting for what seemed like a dog's age before being seen, and then feeling like they were rushed through the event and treated as less-than-human, and oftentimes as an inconvenience and a whiner. The 1991 movie "The Doctor" starring William Hurt (ironically) had more truth than fiction in the eyes of potential jurists.

To generalize all physicians in this matter is innaccurate and irresponsible. Do you have any idea why wait times are long, why visits are rushed, and why so many doctors are leaving the fold? No, you obviously don't. And your movie reference is a great example of people being swayed by the media and making poorly informed decisions based on such.

Are there lawyers who can take advantage of this poor physician-customer relationship? Sure there are. And for those who handle medical malpractice cases, business is booming - and it's ALL based on the total lack of positive personal relationships between the physician and customer, as people don't sue those they have grown to love and respect and trust. Where there are good personal relationships, people work out any problem without dragging it into court, each armed with "hired guns."

"All"?? That statement in and of itself deprives the post of credibility. Again, no disrespect, simply stating the facts. Absolute statements are rarely accurate, and unless you have struggled to survive in this environment you have no accurate basis for such an outlandish claim. Tens of thousands of people involved in this legal morass/lottery system live every day with the reality that no matter how good they are, how thorough or compassionate, there is ALWAYS an attorney willing to scrounge nuisance money from health care providers and insurance companies. That is reality, that is truth. I have seen many colleagues mowed down by this process, most of them kind, caring and empathetic physicians. And good interpersonal relationships don't hold a candle to jackpot money. Patients have even apologized to physicians as they stated they knew the doc did no wrong, but this was their chance for money.

Physicians have access to considerable marketing support and exceptional psychological services to portray them as angels in white smocks. Not sure where you get that, I can't even begin to fathom. Access how, and with who, and who would pay for all this etherial support? Give me a break.


As someone that appears well read and very intelligent I expected more from you. Little or none of what you say above has basis in fact, it is conjecture and anectdotal, with a lot of idealized memories. If you truly want to accurately comment and contribute do some research, talk with and spend some time with those you so freely castigate. Walk a couple of miles in the shoes of health care providers so that you may accurately comment.
Why do I even care? Because frankly you insult me and many of my colleagues that do what we do with honor and compassion every day. We have and continue to sacrifice personally, emotionally, spritually and financially in an effort to truly personify what a physician should be, and we are NOT the minority. I also will not stand by while more and more misinformation on such an important subject is bandied about.

Posted by Guest (Post 209454)

I'm the first to admit how often I can be wrong. But, just a little, you may not be totally right, either.

However, I do know why people sue. When the technical jargon is stripped away, the underlying story is almost always the same - disrespect, disbelief and lack of trust.

The "jackpot" mentality does exist, but why? How does one convince a population that there is going to be no gain to such suits because the suit will fail due to jury empathy with the physician? And until the medical profession can regain that public confidence, juries will continue to see the suing party as one-of-their-own and the physician as the outsider. That is not right in any sense of the law, but it is what happens.

Are there attorneys who encourage and take cases they shouldn't? Yes! No profession is perfect. Just as there are physicians who perform needless tests for no medical reason, but do so as back-up evidence in case they are sued, and that small minority of others who practice money-collection rather than medicine. We all wish we could rid ourselves of the scurrilous minority in the professions who gets the bulwark of the publicity and we all defend against.

The "walk a couple miles in my shoes" comment goes both ways. I've seen the public after-the-litigious-event and am only sharing what I have received. Of course there are dedicated medical professionals, as there are dedicated all-kinds-of-professionals (including lawyers). However, not wanting to recognize why a problem exists usually results in no change in the situation - or worse.

There was never an intent to insult. And I'm sure your comments regarding lawyers were not meant either as a castigation of the entire legal profession. We all need to examine our professional worlds for where they work, are out of kilter, and where change is necessary for the betterment of all. We are indeed proud of those within our profession - and that is a large majority - who perform ethically and admirably every day. We also loathe those who put us in the position of having to purge them from our ranks and explain to a confused public why these slugs have licenses.

So, if the medical profession sincerely wants to reduce malpractice claims, talk to those to whom the claimants come for the why and how of these claims. When we work together, and willing to amend how we do business accordingly so claims are prevented versus litigated, then costs are indeed affected for everyone.

Posted by Guest (Post 209462)

Never said I was totally right, wouldn't be so delusional as to think so.

Never once did I castigate the entire legal profession.

I also know very well that greed and sloth are bigger reasons for lawsuits than non compassionate or non empathetic physicians. I live and breath in this world every day, and know very well of what I speak. It is pie in the sky mentality to think that if all physicians could somehow have behavior reform that this plague would be arrested. Perhaps (and likely) in the past those were bigger reasons for suits, that simply is not the way it is in today's world. You don't have to agree, but speaking with the experience I have accrued and continue to accrue it is the truth to a great degree. One only need look at all of the commercials promising money for malpractice and drug reactions. It is a part of our culture at this point. That being said, poor communication can increase one's odds of being sued, it simply is no longer the primary reason by any stretch.
I have seen countless patients come in after minor fender benders, slight slips in walmart, and a plethora of other "non injuries" becuase "my lawyer told me to come get checked out". Most of these will get a small settlment to make them go away.
I have seen families sue for expected poor outcomes on terminally ill patients, sue for normal post op complications, nearly all of them without merit and simply for a quick settlement check. Thats the real world. I really hope everyone takes the time to do a little research before making blanket pronouncments that simply are not accurate.

Probably as important as anything else in all of this is what it shows on a larger scale. The problems with health care in general are broad and complicated in some ways. People with little experience or knowledge of the inner workings of this mess will ultimately not take the time to be open minded and the effort to learn. They will base opinions on what the media, politicians, and other ill informed sources offer. It really takes patience, effort , and an open mind to begin to view other aspects of the bigger picture at large. I don't purport to know everything, but I will speak of what I do know without hesitation and with honesty, and hope that it affords people that are willing to learn a little insight they might otherwise have missed. I have found that when I partake in others real world knowledge and experiences I am enlighted in ways I might have otherwise missed.

Posted by Guest (Post 209490)

TORT REFORM!
I don't know exactly what the limitations might be to such reform. As a non-lawyer, I might suggest the following...

• A limit of $250,000 for any claim that does not involve a death or permanent disability.
• A limit of $500,000 for a claim involving a death or permanent disability.
• A requirement that the plaintiff pay the legal expenses of the defendant as well as the court costs if the case brought is unsuccessful.

Unless I've missed something very important, these three simple rules should slow down to flow of medical malpractice lawsuits considerably.

If nothing other than these simple rules were enacted into law, I'd think that he cost of healthcare would drop pretty dramatically. Maybe not enough--but pretty significantly.

Posted by Guest (Post 209504)

I'll restrain myself on tort reform. I just hope tomorrow's paper doesn't have another report of a jury awarding $144 million to some unemployed guy in the hills of Tennessee, who smoked since he was thirteen and now claims he wouldn't have lung cancer if the cigarette companies had warned him properly. After all, we should leave some way for the PI lawyers to make a living.

For a little while at least.

Posted by Guest (Post 209534)

What happens when massive (or excessive in any manner per the insured) awards are by juries is always the same - and PI or any other kind of lawyer are always excused from sitting on juries (judges don't like to be critiqued in the jury room by any lawyer).

When a state court jury decides, with award, to the injured person, the one being sued (and insurance company, who normally defends) immediately appeals. Once the appeal is filed, the original decision (and award) is now on hold until the appeals court has ruled. This can take a couple years, depending on appellate docket. In the meantime, the injured party is no better off than the day day before the lower court decision. If the appellate court rules in favor of the injured party, the insured appeals to the next higher court (often, a state supreme court). That court too has a significant docket, so the clock keeps running. So, despite an original court decision, the injured person still doesn't have a dime all this time.

Enter the insured again - this time offering a deal: For an amount much lower than the original jury award), but paid immediately, the insured will drop all appeals. The injured party, with bills to pay, may haggle to some avail (usually not much) and take the deal. Insurers' negotiation range usually has a base (cost of future litigation, less a couple percent) and a ceiling (policy limit), with the goal to have the injured party take the former. All counsel (and the courts) know this, and it has been often insinuated that courts drag appeals to give the parties time to resolve the matter in pre-appellate settlement negotiations, as courts rarely want to place themselves in positions to reverse jury decisions.

So, payoffs of these jury awards which sound like a PowerBall winner, are rarer than hen's teeth. Thus, while the original jury award made great press, the actual cash exchanging hands is much less.