Comments on: An ectopic pregnancy case shows how defensive medicine hurts patients http://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html Tue, 14 Feb 2012 23:00:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53742 Anonymous Thu, 30 Jun 2005 20:47:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53742 I believe that a valuable reform would be a combination of a cap on non-economic damages (to be determined by wiser heads than I) as well as provisions in a med-mal policy that binds the insurer to fight suits in court if the doc requests it. Trial costs may raise premiums for a shour period of time, but I believe that the long term impact would be a reduction of frivolous filings. The thought behind this is that the predatory attorneys look for a quick settlement, while legitimate med-mal barristers would be willing to "go to the mat" with their client. We do need med-mal attorneys, but we also need to curb the predatory nature of certain firms. /2cents<br/>Matt I believe that a valuable reform would be a combination of a cap on non-economic damages (to be determined by wiser heads than I) as well as provisions in a med-mal policy that binds the insurer to fight suits in court if the doc requests it. Trial costs may raise premiums for a shour period of time, but I believe that the long term impact would be a reduction of frivolous filings. The thought behind this is that the predatory attorneys look for a quick settlement, while legitimate med-mal barristers would be willing to “go to the mat” with their client. We do need med-mal attorneys, but we also need to curb the predatory nature of certain firms. /2cents
Matt

]]> By: Anonymoushttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53731 Anonymous Thu, 30 Jun 2005 02:11:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53731 I jumped in on the tail end of #5 so I dont think my story of getting sued, wrongly I think, and settling for a large amount of money to avoid the possiblity of a multimillion decision, was read. After this case, I found that I was thinking about every patient I saw, not in terms of what was the best thing to do medically, but what would sound best to a lay jury in court. I realized that I was making poor decisions and stopped delivering babies at all. Ironically, I ran into the lawyer who sued me, at a social gathering some time later and he said to me, "No hard feeling, I hope, it is just business." I suggested that he kiss my ass. It wasnt business, it was my life. I defined myself in the care and concern I have for my patients and lived daily with the knowlege and responsibility that their lives and the lives of their children were in my hands. To be called incompetant and callous and told that I caused the crippling of a child was more than I could live and work with. Someone else can do the deliveries. There was a case I heard about, hearsay only, I confess, from Georgia. A group was sued and lost. The next year the lawyer who had done the suing was pregnant and the only ob nearby was the sued (sp?) doctor. When she showed up int the office for prenatal care, he told the lawyer that he could not imagine her consulting with a physician that she had called incompetant in open court and told her to go up to Savannah where there were some good doctors. I jumped in on the tail end of #5 so I dont think my story of getting sued, wrongly I think, and settling for a large amount of money to avoid the possiblity of a multimillion decision, was read. After this case, I found that I was thinking about every patient I saw, not in terms of what was the best thing to do medically, but what would sound best to a lay jury in court. I realized that I was making poor decisions and stopped delivering babies at all. Ironically, I ran into the lawyer who sued me, at a social gathering some time later and he said to me, “No hard feeling, I hope, it is just business.” I suggested that he kiss my ass. It wasnt business, it was my life. I defined myself in the care and concern I have for my patients and lived daily with the knowlege and responsibility that their lives and the lives of their children were in my hands. To be called incompetant and callous and told that I caused the crippling of a child was more than I could live and work with. Someone else can do the deliveries. There was a case I heard about, hearsay only, I confess, from Georgia. A group was sued and lost. The next year the lawyer who had done the suing was pregnant and the only ob nearby was the sued (sp?) doctor. When she showed up int the office for prenatal care, he told the lawyer that he could not imagine her consulting with a physician that she had called incompetant in open court and told her to go up to Savannah where there were some good doctors.

]]> By: Curious JDhttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53721 Curious JD Wed, 29 Jun 2005 15:21:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53721 Sixwings,<br/><br/>I have no doubt that doctors are scared. And I appreciate what they are saying. I have no doubt that they are getting squeezed. That's the problem. <br/><br/>But the facts just aren't there to back up many of their claims about how medical malpractice works. And more importantly, their proposed solutions to their perceived problems don't solve them. And I'm not talking about the solutions idly discussed here, I'm talking about the ones that actually are being seriously discussed in the legislature. Sixwings,

I have no doubt that doctors are scared. And I appreciate what they are saying. I have no doubt that they are getting squeezed. That’s the problem.

But the facts just aren’t there to back up many of their claims about how medical malpractice works. And more importantly, their proposed solutions to their perceived problems don’t solve them. And I’m not talking about the solutions idly discussed here, I’m talking about the ones that actually are being seriously discussed in the legislature.

]]> By: Sixwingshttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53719 Sixwings Wed, 29 Jun 2005 14:39:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53719 Curious JD, <br/> How many doctors does it take before you consider the idea that there may be a problem? Seriously no matter how many times people bring up these points you swat them away no busy with your own points to truely listen to others. Isn't it worth relly looking at what the doctors are saying and not deciding that you're right even if everyone else says your wrong. you may still be right but an open mind does not seem to be your strong point. Curious JD,
How many doctors does it take before you consider the idea that there may be a problem? Seriously no matter how many times people bring up these points you swat them away no busy with your own points to truely listen to others. Isn’t it worth relly looking at what the doctors are saying and not deciding that you’re right even if everyone else says your wrong. you may still be right but an open mind does not seem to be your strong point.

]]> By: Curious JDhttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53712 Curious JD Wed, 29 Jun 2005 00:08:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53712 Darcy, I can't open that link. But I would be that, except for certain specialties, the chance of being sued or having to pay a claim is less than 10%. Especially given the number of physicians with multiple claims. I can't find a solid source either. The insurers have that info, but they don't appear to have released it. But since you don't know that, how do you justify your fear? Builders get sued all the time, do they live in desperate fear of lawsuits? So do truck drivers? <br/><br/>What's the point of having insurance if they won't stand by you when you are accused of harming someone? What do you pay those premiums for? <br/><br/>I agree with you, I don't think lawsuits are a good deterrent for modifying the actions of a professional. To me, that's always been the weakest argument, since 9 times out of 10, the issue is straight negligence when we're talking about an individual physician. I believe the goal is compensating the injured party for the harm when that harm is the result of another's negligence.<br/><br/>Of course, many tort reform proposals apply to all providers, and I think the threat of punitive damages serves a valuable function when dealing with companies. <br/><br/>As to legal malpractice, there are a number of attorneys out there who practice in this area. But there just aren't a lot of statistics out there on the issue so I can't tell you much about it. I'm sure the insurers have the details, though, as they are the ones betting on the risk. Darcy, I can’t open that link. But I would be that, except for certain specialties, the chance of being sued or having to pay a claim is less than 10%. Especially given the number of physicians with multiple claims. I can’t find a solid source either. The insurers have that info, but they don’t appear to have released it. But since you don’t know that, how do you justify your fear? Builders get sued all the time, do they live in desperate fear of lawsuits? So do truck drivers?

What’s the point of having insurance if they won’t stand by you when you are accused of harming someone? What do you pay those premiums for?

I agree with you, I don’t think lawsuits are a good deterrent for modifying the actions of a professional. To me, that’s always been the weakest argument, since 9 times out of 10, the issue is straight negligence when we’re talking about an individual physician. I believe the goal is compensating the injured party for the harm when that harm is the result of another’s negligence.

Of course, many tort reform proposals apply to all providers, and I think the threat of punitive damages serves a valuable function when dealing with companies.

As to legal malpractice, there are a number of attorneys out there who practice in this area. But there just aren’t a lot of statistics out there on the issue so I can’t tell you much about it. I’m sure the insurers have the details, though, as they are the ones betting on the risk.

]]> By: drdarcyhttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53711 drdarcy Tue, 28 Jun 2005 23:51:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53711 Hi CJD,<br/>Okay, the 50% cite is this paper (Med Econ. 1988;65:38-41.) I was disappointed that it was older data, so I tried to find some newer data.<br/>This is an interesting paper looking at medical complaints in speciality and surgical practices, (Hickson et al JAMA. 2002;287:2951-2957), this looks at pediatric cases that were filed and settled (Pediatr Emerg Care. 2005 Mar;21(3):165-9.) Both note that physician "niceness" (good communication, time spent with pt/family, etc) is a major predictor in not getting sued. The peds one notes that the majority of the sued docs had been sued before, that the majority of the claims involved more than one defendant, 93% of cases settled, and that "many claims were frivolous." Unfortunately, neither paper was able to truly address the question at hand: the lifetime risk of suit for any given physician. So, over the last twenty years, perhaps it's stayed the same. For the sake of argument, let's say it's dropped to 1:3, 1:4, or 1:10. <br/>Sorry, even if it's 1:10, I still remain frightened of getting frivolously sued by someone who didn't think I was nice enough. <br/>And, sorry, but I remain more frightened of the financial/social/personal costs involved in being a defendant in a medmal lawsuit, than of my "right" ask for huge damages being impinged.<br/>Lawsuits are a tool.<br/>I don't think lawsuits are a good tool for modifying the behavior of groups of professionals. I don't think there's any evidence medmal lawsuits have made medicine (as a whole) safer. <br/>You may disagree, I'd be happy to see your argument. <br/>And, I'll ask again ... if lawsuits are such a great tool for modifying professional behavior, why aren't more attys suing other attys for legal malpractice? Hi CJD,
Okay, the 50% cite is this paper (Med Econ. 1988;65:38-41.) I was disappointed that it was older data, so I tried to find some newer data.
This is an interesting paper looking at medical complaints in speciality and surgical practices, (Hickson et al JAMA. 2002;287:2951-2957), this looks at pediatric cases that were filed and settled (Pediatr Emerg Care. 2005 Mar;21(3):165-9.) Both note that physician “niceness” (good communication, time spent with pt/family, etc) is a major predictor in not getting sued. The peds one notes that the majority of the sued docs had been sued before, that the majority of the claims involved more than one defendant, 93% of cases settled, and that “many claims were frivolous.” Unfortunately, neither paper was able to truly address the question at hand: the lifetime risk of suit for any given physician. So, over the last twenty years, perhaps it’s stayed the same. For the sake of argument, let’s say it’s dropped to 1:3, 1:4, or 1:10.
Sorry, even if it’s 1:10, I still remain frightened of getting frivolously sued by someone who didn’t think I was nice enough.
And, sorry, but I remain more frightened of the financial/social/personal costs involved in being a defendant in a medmal lawsuit, than of my “right” ask for huge damages being impinged.
Lawsuits are a tool.
I don’t think lawsuits are a good tool for modifying the behavior of groups of professionals. I don’t think there’s any evidence medmal lawsuits have made medicine (as a whole) safer.
You may disagree, I’d be happy to see your argument.
And, I’ll ask again … if lawsuits are such a great tool for modifying professional behavior, why aren’t more attys suing other attys for legal malpractice?

]]> By: Curious JDhttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53709 Curious JD Tue, 28 Jun 2005 21:26:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53709 "If I know that most docs get sued at least once (most being more than 50%)"<br/><br/>Darcy, what's your source for this figure. I'm almost certain it's wrong.<br/><br/>"And, caps on non-economic damages do seem to make it less likely that someone with a weak case is going to be able to talk an atty into taking a case on contingency. Maybe I'm wrong. But I do feel safer. Superstitious behavior on my part? Perhaps. I guess we'll see."<br/><br/>Indeed, I believe we will. You're in a state with tort reform - which one is it? If it's one that has had it for a long time, we should be able to determine the effetiveness.<br/><br/>You know, you say that lawyers are the thing that goes bump in the night for you, but if someone in your family were the victim of medical malpractice, who would you turn to? If, as is usual, the physician stonewalled and that person was looking at mountains of medical bills and years of care, where would you go for assistance?<br/><br/>It seems that many physicians can't contemplate ever needing a lawyer. Do you really believe you'll never be in a car wreck? Never be cheated on a contract? Never have any of the things that people come to see lawyers for happen to you? If you make it harder for you to recover, how does that help you? And if it doesn't help you, who does it help? “If I know that most docs get sued at least once (most being more than 50%)”

Darcy, what’s your source for this figure. I’m almost certain it’s wrong.

“And, caps on non-economic damages do seem to make it less likely that someone with a weak case is going to be able to talk an atty into taking a case on contingency. Maybe I’m wrong. But I do feel safer. Superstitious behavior on my part? Perhaps. I guess we’ll see.”

Indeed, I believe we will. You’re in a state with tort reform – which one is it? If it’s one that has had it for a long time, we should be able to determine the effetiveness.

You know, you say that lawyers are the thing that goes bump in the night for you, but if someone in your family were the victim of medical malpractice, who would you turn to? If, as is usual, the physician stonewalled and that person was looking at mountains of medical bills and years of care, where would you go for assistance?

It seems that many physicians can’t contemplate ever needing a lawyer. Do you really believe you’ll never be in a car wreck? Never be cheated on a contract? Never have any of the things that people come to see lawyers for happen to you? If you make it harder for you to recover, how does that help you? And if it doesn’t help you, who does it help?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53707 Anonymous Tue, 28 Jun 2005 18:34:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53707 "Medmal lawyers are the professional equivalent of genital herpes - it won't kill you, but you sure don't want them on you."<br/><br/>lol - how true. “Medmal lawyers are the professional equivalent of genital herpes – it won’t kill you, but you sure don’t want them on you.”

lol – how true.

]]> By: drdarcyhttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53706 drdarcy Tue, 28 Jun 2005 18:29:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53706 whoops, that would be "error rates have been too high" (okay, maybe I don't agree with that statement all that much, but I'll give CJD the point ... any error rates, medical *or* legal ... are best reduced) whoops, that would be “error rates have been too high” (okay, maybe I don’t agree with that statement all that much, but I’ll give CJD the point … any error rates, medical *or* legal … are best reduced)

]]> By: drdarcyhttp://www.kevinmd.com/blog/2005/06/ectopic-pregnancy-case-shows-defensive-medicine-hurts-patients.html#comment-53705 drdarcy Tue, 28 Jun 2005 18:24:00 +0000 http://clients.emmense.com/kevinmd/2005/06/i-practiced-defensive-medicine-today-6.html#comment-53705 Hi CJD,<br/>As always, a pleasure. I'd agree that error rates for many medical specialities have been too low and too stable for too long. I agree that this is a serious problem, and that the healthcare professions have not done enough to change it. I do not agree that medmal suits have done anything to improve this state of affairs, nor will they ever, no matter how big (or small) the judgments. <br/>So why do I support tort reform?<br/>Purely selfish reasons.<br/>Your medmal colleagues, CJD, are the Thing That Goes Bump In The Night for me. The professional equivalent of shingles, or genital herpes ... I know it's not going to kill me, but boy do I hope I never have personal experience ... <br/>If I know that most docs get sued at least once (most being more than 50%), and if I cannot find a *single* colleague who has a story like ... "so, yeah, I got sued, but, you know, it was kind of interesting and not really that bad ..." well, my amygdala doesn't like that so much. <br/>So, I think you're right- tort reform won't "fix the system."<br/>I also think people are scared, for good reason, and fear leads to poor judgment (even in smart, well-trained people) and sometimes to very stupid behavior, as possibly demonstrated by this week's story.<br/>And, caps on non-economic damages do seem to make it less likely that someone with a weak case is going to be able to talk an atty into taking a case on contingency. Maybe I'm wrong. But I do feel safer. Superstitious behavior on my part? Perhaps. I guess we'll see.<br/>A question for you ... why is so hard to take a *legal* malpractice case forward? We had a real whack-job atty in our area, messed up cases for about 6 of my patients alone ... none of them could find any legal remedy for that particular problem. What's up here? Hi CJD,
As always, a pleasure. I’d agree that error rates for many medical specialities have been too low and too stable for too long. I agree that this is a serious problem, and that the healthcare professions have not done enough to change it. I do not agree that medmal suits have done anything to improve this state of affairs, nor will they ever, no matter how big (or small) the judgments.
So why do I support tort reform?
Purely selfish reasons.
Your medmal colleagues, CJD, are the Thing That Goes Bump In The Night for me. The professional equivalent of shingles, or genital herpes … I know it’s not going to kill me, but boy do I hope I never have personal experience …
If I know that most docs get sued at least once (most being more than 50%), and if I cannot find a *single* colleague who has a story like … “so, yeah, I got sued, but, you know, it was kind of interesting and not really that bad …” well, my amygdala doesn’t like that so much.
So, I think you’re right- tort reform won’t “fix the system.”
I also think people are scared, for good reason, and fear leads to poor judgment (even in smart, well-trained people) and sometimes to very stupid behavior, as possibly demonstrated by this week’s story.
And, caps on non-economic damages do seem to make it less likely that someone with a weak case is going to be able to talk an atty into taking a case on contingency. Maybe I’m wrong. But I do feel safer. Superstitious behavior on my part? Perhaps. I guess we’ll see.
A question for you … why is so hard to take a *legal* malpractice case forward? We had a real whack-job atty in our area, messed up cases for about 6 of my patients alone … none of them could find any legal remedy for that particular problem. What’s up here?

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