More than 50% of malpractice is caused by less than 1% of doctors.

Medical malpractice insurance is primarily set to go up or down with the stockmarket because insurance payments are invested. Low stock market = higher insurance rates.

If we could get rid of lousy doctors and have a robust stock market, insurance would certainly be manageable.

That said, defensive medicine certainly has some relationship to insurance rates. The important question is whether this is right. The problem with treating over the phone is that there is always a chance of misdiagnosis. If you think the patient should accept this slim risk, this would lower insurance rates a little bit.

On another note, yes there are many frivilous law suits. They rarely, if ever, succeed. My firm frequently sees them and frequently gets them dismissed. This still costs several thousands $ though and I can understand doctors frustration with this, but to suggest that frivolous lawsuits dominate is a gross exaggeration. I personally can see no better way to do things…

Just my thoughts…

1) I never treat eye disorders sight-unseen. On several occasions I have agreed to meet patients in the hospital er or lobby to examine the eye – the no- show rate on these meetings was 50%.

2) The delivery 30 years ago also may have been aided by the use of amnestic medications, which are no longer used today (and may be harmful)

3) If I call my attorney on the phone and ask for and receive advice over the phone, do I not get a bill?

Rich, MD

IANAO

(I am not an obstetrician, just a psychiatrist) not even an American rather a curious observer from across the Atlantic.

There are many possible explanations.

1) Were you a smaller baby than your child? It is my understanding that babies are getting heavier on average.

2) Was your mother a bigger woman than your wife?

3) Differences in the anatomy of the pelvis between your wife and your mother?

4) Different age and parity status. Was this your wife’s first baby and your your mother’s 2nd or 3rd? Maternal age at first baby rising in some Western countries.

5) Recall bias. You weren’t there (in an observational sense) at your own birth. Your mother’s generation probably more stoical than ours. It could have been bloody awful for her. She might not have wanted to make you feel bad.

6) Bad luck. **it happens.

These are a range of alternatives to the implicit “doctors are getting more incompetent” hypothesis you advance. That’s not to say your hypothesis is not correct, just that your study design is flawed.

My understanding of the stats in this area (hazy at best) is that, this side of the pond anyway, there has been no steady rise in maternal mortality and morbidity as your hypothesis would predict.

Best wishes

Fionn

-Doc T. Rsardum

* 59% of respondents said they ordered unnecessary diagnostic tests — most often imaging studies. Seventy percent of emergency physicians said they ordered unnecessary scans.

* 52% of all physicians said they referred patients when referrals were not medically necessary.

* A third of physicians said they prescribed drugs that weren’t medically necessary, and the same percentage said they performed unnecessary invasive procedures.

* Breast cancer was a particular target for defensive medicine, with radiologists either referring questionable results for biopsy or refusing to perform mammograms altogether.

* There was no link between physicians’ actual experience of litigation and their practice of defensive medicine, but physicians who lacked “confidence in their liability insurance” and those who expressed concern about the financial burden of insurance premiums were more likely to practice defensive medicine.

* Physicians are more likely to refuse care to workers’ compensation patients and obese patients, both groups perceived as potentially litigious.

And what’s more, that you know exactly how much your insurer has paid out over the last decade and how much it has collected, as well as what it’s investment income was, whether it made intelligent financial decisions, etc. And of course, what its overhead is, and how much that will be reduced and how much of those savings will be passed on to you, not to mention the consumer, now that you have “reform.”

And of course, you’ve also measured the societal benefit by determining exactly how many physicians will return to these places as well as how many left, exactly how much and for how long rates will decrease, and how much your insurer is going to save? And of course, how these savings will be passed on to society in the form of lower health care costs?

I know you’ve done that kind of rigorous analysis, because otherwise, you would never make such vague and unsupportable statements, correct?

But of course you have.