Response to the recent NY Times article on physician insensitivity:

Your article (“When the Doctor Is in, but You Wish He Weren’t”) was interesting. It is inevitable as doctors get more and more pressure to see larger numbers of patients that encounters would become more impersonal. After all, isn’t this the same complaint that happens with Home Depot as opposed to the local hardware store?

But the solutions proposed in the article are inappropriate. What is happening is that doctors are told to be nicer and to spend more time with patients. Yet they are told to spend less time with patients by Medicare and administration bent on making money. Isn’t this a schizophrenic management practice? Isn’t this making the correct diagnosis but giving the incorrect treatment

The source of the problem is increasing time pressures and decreasing pay. Why is no one addressing the source of the problem? That in itself is like giving cholesterol medicine without giving any instruction on diet and exercise. At some point the system breaks down.

Comments are moderated before they are published. Please read the comment policy.

  • S.

    “it is inevitable as doctors get more and more pressure to see larger numbers of patients that encounters would become more impersonal.”

    Who is responsible for treating each patient properly? Medicine is a profession, not a mere technician’s job. Physicians are not clerks at the Home Depot.

    Physicians who change their practice to maximise profit (whether self-directed or at the urging of other interested parties) must necessarily stop at the point before patient care is inadequate.

    Demand higher fees if you must, but you are required by your allegiance to the profession, which supercedes any allegiance to employer or third-party payer, to set standards.
    ….
    Also,
    Time pressures do not explain why a physician would refuse to tell a patient she tested positive for Hepatitis A.

    Time pressures do not excuse a doctor who berates a patient in stirrups, using humiliation as a tool to gain compliance.

    And the point of the article was, there is no good way to pinpoint the odd ducks who, whether as a result of “pressures” or personal inadequacies, are chasing away from a practice, or even injuring patients.

    With the “vote with your feet” method of dealing with docs, The bad communicators just stay bad and there is no way to identify them ahead of a visit or “pressure” them do anything differently.

  • Samson Isberg

    Interesting. Even though our Health Systems are so different, the problems seem to be the same.
    Some doctors are quite unable to deal with patients at all, due to (I think) faulty upbringing, not by the medical school, but by their parents. They’re rude, self-centered and non-empathic. I would suggest that these people are given the advice early on to quit medical school and look for something else to do, e. g. Law school, Organized Crime, Wrestling etc. If they do insist of going through medical school, why not try to put them where they can’t do any harm – research, biochemistry – or, failing that, let them join the Board of Health where personalities like that are appreciated.

  • Anonymous

    Why does it always seem easier to complain rather than actually seek another doctor or pay to see someone you prefer out of plan?

    If it is just a personality issue, then find someone else who you get along with better.

    If it is an under-reimbursed and overworked physician, then decide either that more personal attention is worth paying more, and seek a practice that gives you the time and attention you want, and pay for it, or settle for what you will pay for and shut up. You aren’t entitled to have something for nothing, or for less that fair payment–yours or your insurer’s.

    Whining to a newspaper reporter that the time spent with your doctor is insufficient or that your doctor doesn’t give you 30 minutes for a 15-minute payment is not owning your problem. It is failing to take responsibility. Why not do something constructive, write
    your congressman.

  • Anonymous

    To Anon from 1:05:
    The patient mentioned in the original article was not whining about the doctro’s spending 15 minutes instead of 30; she was “whining” aobut a doctor’s refusing to tell her she had Hepatitis A.

    This was not simply a question of bad bedside manners – this was endangering public health as well as violating the patient rights to know her diagnosis. This case should’ve been reported.

    Incidentally, doesn’t every US patient has a right to know his/her diagnosis? If I as a patient ask a direct question “what is my diagnosis” – I have a right to the honest answer, don’t I? If you don’t have time for an answer, send the lab results in the mail – how much time does this take?

    If the doctor refuses to disclose my lab results, you bet, I am going to complain. All the way to the board. This is not about bedside manner, it is about patient rights. And the answer “it is a virus” doesn’t constitute an honest answer for someone who has Hepatitis A.

  • Samson Isberg

    Anon 2:08, (it would be easier if you chose some nick, like Mickey Mouse for instance), you certainly have a valid point here. One can only guess at the reasons the doc had for not disclosing what virus the patient had – none of them good.

    All right, maybe he/she was short of time; if so, why not say so? Something in the line of “Listen, lady – you have Hepatitis A. Go talk to your regular physician about it, do it soon, you will not die, but use your own toilet from now on and wash your hands EVERY TIME you’ve been there, – and let your husband or eldest child do the cooking for a while.”

    That would take about 3 seconds to say.

  • S.

    “Why does it always seem easier to complain rather than actually seek another doctor or pay to see someone you prefer out of plan?”

    That’s kind of a straw man, if you are complaining about the article or the patients in the article. The patients for the most part fled the physicians in question, without even informing the doctor, let alone anyone else, of their dissatisfaction.

  • Anonymous

    Most patients will go with their HMO flow, even if all they get is lousy service.
    We, as physicians, on the other hand, have a moral obligation to say NO to an employer. We can’t just hide behind a big group and complain that there is no way out.

  • Anonymous

    “Most patients will go with their HMO flow, even if all they get is lousy service.”

    Yes–precisely. Why? (i) Because medicine is a protected monopoly. Monopolies reduce output/quality, increase price. Solution: eliminate licensure requirements.

    Oh–but that would cut into your profits. Can’t have that.

    (ii) Because patients don’t really pay for medical services; insurance companies do. Solution: expand HSAs. Oh, but that would make patients into customers who make demands . . . can’t have that–at least if KevinMD is reflective of the general view.

  • Anonymous

    When you’re a demigod, do you really have time to worry about feelings?

  • Anonymous

    I have a great doc. I had to sift through a few duds to find one I really liked – but it was worth it. I think it’s not so much the amount of time spent with a patient – it’s more the perception of how the time is spent. Did the doctor listen? Did he cut you off while you were trying to say something? I wouldn’t say my doctor spends loads of time with me during an appointment – but the time he does spend is quality. He makes eye contact, he stops writing for a few seconds while I talk… It’s the small things like that that make a difference.

  • Anonymous

    (And, the doctor who treats me respectfully doesn’t cost me a penny more. I would trade 30 minutes with a bad physician for 1/2 the time with a good one any day)

  • Anonymous

    Protected monopoly my ass.

    Yes we have such a well protected monopoly that nurse practioners have replaced MDs in many areas.

    We have such a stronghold monopoly on medicine that physicians assistants routinely RUN rural ERs and small clinics with no doctor oversight whatsoever.

    We are such a monopoly machine that we take more foreign doctors per year THAN ALL OTHER NATIONS COMBINED

    We are so worried about protecting our monopoly that we have one of the HIGHEST PER CAPITA DOCTOR/PATIENT RATIOS IN THE INDUSTRIALIZED WORLD.

    Half of all people get accepted to medical school. I guess you think we should allow the bottom half of the applicants to become doctors now.

    Thats funny, because usually you read articles about how doctors are bad and make mistakes. But you want to REDUCE licensure/regulations and allow even more bad apples to become doctors? That makes a lot of sense.

    Next time before you spout off about monopolies, please do your research first

  • Anonymous

    Excuse me, anon 1.49, but you are perhaps so obsessed with retaining your monopoly rents that you have abandonned your reason. Allow me to refute your points seriatum.

    1. PAs. Do you remember the legislative battles that allowed nurse practitioners to do anything? You point to one breach in your moat and claim your castle is collapsed. How absurd! If markets ran things, so much more of routine medical care would be done by non-physicians. Each tiny breech of your medical monopoly: from nurse anesthesiologists to presecription privileges for optometrists bring nothing but good–but we have a long way to go.

    2. Foreign doctors are subjected to ridiculous “clinical” exams that many claim are simply barriers to entry that the medical community creates.

    3. Yes, we have a high doctor per capita rate. So what? Demand may be such that if people had their druthers w/o monopoly, we’d have more. Remember the rest of the industrialized world has nationalized medicine.

    4. I really don’t know how well one does on the MCATs correlates to being a good doctor–and neither do you. Nobody does. To assume there is some sort of lawlike relationship between test performance and life performance is well, not a scientific claim.

    If there were no licensure, doctors would have to prove to patients that they were qualified, i.e., they’d be more information about whether they have done certain procedures and how well they do it. They couldn’t rely on their credentials. That’s an improvement.

  • Anonymous

    So, in your opinion, how many deaths from malpractice would you need to demonstrate that a “physician” was not qualified?

  • Rita Schwab – MSSPNexus

    Anonymous says “If there were no licensure, doctors would have to prove to patients that they were qualified…”

    What a frightening thought – physicians (or people who’ve decided to run for doctor) campaigning for patients like politicians for votes. ‘I want to be your doctor! And in case you’re undecided, let me sling a little mud at my opponent in the office across the hall…’

    No thanks.

  • Anonymous

    Anon 2:12-

    In order to qualify for specialty board certification and sit for the exam, you have to be certified in multiple procedures. Same goes for getting creditialed for hospital privileges. Licensure and specialty board certification is the way to make sure that doctors are qualified.

    Also, the “ridiculous ‘clinical’ exams” that you mention that foreign doctors have to take? American trained grads have to take the same ones. USMLE parts 1,2 and 3 are required for licensure and include a clinical section.

    NH Doc

  • Anonymous

    Dear Anons,

    Eliminating the legal requirement for licensure does not mean that doctors would not seek credentials. THe wise consumer would not generally seek care from a person who did not go to medical schoo, pass certain test, etc.

    HOWEVER, without the the legal requirement, people who are qualified to do certain work WITHOUT a degree could do so. They could prove their abilities by experience or an impressive work record.

    This would lower barriers to entry, increase competition, lower cost, and improve quality–who could be against that?

    as for the the comment “What a frightening thought – physicians (or people who’ve decided to run for doctor) campaigning for patients like politicians for votes.” why is that frightening except to those who fear using their independent judgment and must be led around like cattle by a self-elect professional elite?

  • Anonymous

    Anon 2:12:

    Are you utterly ignorant of the history of medical practice in this country? Prior to the reforms brought about after the Flexner Report and early 20th century legislation, the situation you seem to advocate applied, and it was a disaster. What we have today, whether you like it or not,is a response to the abuses of the past, where people pretty well could practice without accredited training or licensure.

  • Anonymous

    “Foreign doctors are subjected to ridiculous “clinical” exams that many claim are simply barriers to entry that the medical community creates”

    USMLE exams are a breeze if you have half a brain. My board exams (emergency medicine) were easy too (95% pass rate). In Canada and Britain the exams are MUCH MUCH Harder. THE Hardest exam most FMGS have to pass to work in the US is the citizenship exam, since the US now considers all foreigners possible AL Queda terrorists.

  • Anonymous

    The FLEXNER REPORT!!!! What a load of cr–. That was nothing but a thinly described vehicle for the AMA. Here’s an excerpt of a historical account describing the Report. Hey, doc–stop the self-serving lies.

    The Flexner Report of 1910 was a disguised repeat of AMA’s 1906 inspection of medical schools. AMA didn’t publish its 1906 findings or use them as a basis for closing schools because of the obvious appearance of conflict of interest. The Flexner Report, a proxy undertaken by the Carnegie Foundation, looked like a much more effective route, and it was.[6] Furthermore, Abraham Flexner was accompanied on his inspection by the AMA’s N.P. Colwell who took care to make sure that the new report would mirror AMA’s 1906 findings. Finally, Flexner spent a great of deal of time at AMA’s Chicago headquarters preparing his report. Cutting to the chase, one ultimate effect of the report was to keep the number of doctors per 100,000 people in the U.S. by 1963—143—at the same level it was at in 1910. In number, medical schools went from a high of 166 around the time of Flexner to just 77 by the 1940s—a 54 percent reduction.[

  • Anonymous

    Anon 7:49, I’ll call your bluster.

    Your ad hominem against Abraham Flexner, and whomever he chose to associate with nearly a century ago in preparing his report, and whatever foundation funded the research is irrelevant. What evidence, except for your citation of the ratio of medical schools to population–another utterly meaningless figure since it says nothing of the quality of those schools that preceded the reforms nor of the quantity of doctors graduated before then–is there to suggest there are fewer legitimate doctors per capita now than before. You can’t, that is why.

    So enough of your own lies and dissembling. You can shovel your own load of “cr–.”

  • Anonymous

    Why can’t you docs ever just say you’re wrong? Flexner WAS biased by his association with the AMA; I think that’s an historical fact, not an ad hominem attack.

    The constant number of doctors does suggest that doctors and organized mafia, eh, medicine, did limit the number of docs.

    As for the number of “legitimate doctors,” I’d trust the market to sort that out, not a bunch of self-serving doctors who cannot rationally discuss the economics of their profession.

  • Anonymous

    OK,

    I admit I am wrong. Come to my website http://www.MDdiploma.com. Send my 200K and I will send you a diploma within 24 hours to do whatever you want with it.

  • Anonymous

    “As for the number of “legitimate doctors,” I’d trust the market to sort that out, not a bunch of self-serving doctors who cannot rationally discuss the economics of their profession.”

    There is no market, that’s the thing. The vast majority are judged on price by insurance plans.

    But you did get the second part right.

    CJD

  • Anonymous

    I was waiting until you chimed in CJD.

    Why is it not possible to “read” for the bar exam as in times past? Seems as if your profession, such as it is, has a position on who should be thought eligible to take a bar exam and practice law. Are you saying that the same sorts of rules that apply to lawyers as a professional group should not also apply to doctors? If so, why? Makes logical sense to me, for an illogical doctor as you might have me.

  • Anonymous

    Once again CJD show himself to be an internet flamemaster. Now where do I send that 20K for an instant JD diploma.

  • Anonymous

    I have no comment on your licensing procedures. Why can’t you read for the bar anymore? I really don’t know – probably the same reasons you can’t practice medicine. Ostensibly to protect the public, but the fees generated to the various associations don’t hurt.

    My only comment is that yours is not a market based profession. Your fees are set by third parties, over 50% of health care dollars come from the government, and the public has no basis upon which to form an opinion about your relative skills.

    I also agree with him that many physicians don’t understand the economics that affect their practice. And I think if you talk to bankruptcy attorneys and financial planners, you’ll learn that physicians are the most likely of professions to be suckered by financial scams. And I empathize with you, because balancing the practice of your profession with the business side is one of the things most attorneys and physicians have in common. It’s at times harder to be a businessman/woman.

    CJD

  • Anonymous

    “And I think if you talk to bankruptcy attorneys and financial planners, you’ll learn that physicians are the most likely of professions to be suckered by financial scams.”
    Any data to prove your claim? Hearsay is not evidence, counsel.

  • Anonymous

    I don’t claim to have hard evidence. I doubt there is any way to objectively prove that claim. It’s just an observation based on personal experience.

    And actually, hearsay is evidence, it’s just often not admissable. But it can be admissable.

  • Anonymous

    I think you can read law still in some jurisdictions, if you can find someone to sponsor/teach you. I think drs are miffed at being treated like hired help. CJD is right, sometimes the hardest part of practicing law is balancing the business side of it [aka making a living] against doing the work properly. I pity drs for the mess they are in, stuck between a rock and an insurer…what to do, what to do. The solution most often heard here is to stop malpractice claims by capping the damages — as in, ‘let’s hurt the people who are reliant on us and who are already hurt.’ what’s wrong with this picture? everything — to everyone except the drs. If my legal assistant gave out legal advice the way medical office receptionists do, we’d be in the same mess dr’s offices are. Walk away from the insurance companies, just walk away.

  • ismd

    “The solution most often heard here is to stop malpractice claims by capping the damages — as in, ‘let’s hurt the people who are reliant on us and who are already hurt.’ what’s wrong with this picture? everything — to everyone except the drs.”

    Capping damages is only part of the solution. Tightening the rules to prevent BS claims from going to trial, making sure expert witnesses are truly experts in the field of the defendant, capping legal fees, and specialty health courts are among many additional solutions to the litigation problem. The only reason caps keep coming up on these comments is because the attornies keep bringing up the subject to try to damn the doctors. Look at other posts in the past – these ideas have been discussed here before. And caps on non-economic damages do NOT hurt the plaintiff – just the lawyers in charge of the case. The economic damages are still given.

    “Walk away from the insurance companies, just walk away.”

    Many of us are trying to do just that. In my area of South Jersey, it isn’t as easy as you think to do that, because of the economic status of patients in the area in which we practice.

  • Anonymous

    “And caps on non-economic damages do NOT hurt the plaintiff – just the lawyers in charge of the case. The economic damages are still given.”

    Hello? Did you read what you wrote before you posted it? How much is it worth to someone for ruining the quality of the rest of their lives? So your medical expenses and your rent for the rest of your life are covered, but spending the rest of your life say in a wheelchair, well, that’s just tough, even though the doctor was negligent?

    Oh yeah, and I made a bad analogy before: my legal assistant would give out much better legal advice than my doctor’s receptionist’s medical advice. When you’ve got high school graduates performing triage, you’re surprised you end up with legal problems and patients running to concierge medical care?

  • Anonymous

    “Hello? Did you read what you wrote before you posted it? How much is it worth to someone for ruining the quality of the rest of their lives?”

    So, you tell me – how much is it worth? Give us a formula for calculating pain and suffering, instead of these overdramatizations and generalizations you spout about the injured patient. You always want facts and figures, so give us a way of calculating damages. I’ll bet you can’t.

    “Oh yeah, and I made a bad analogy before: my legal assistant would give out much better legal advice than my doctor’s receptionist’s medical advice. When you’ve got high school graduates performing triage, you’re surprised you end up with legal problems and patients running to concierge medical care?”

    Receptionists at a doctors office don’t give out advice on their own – if they do, they need to be fired. If anything, all questions are run by the physician first before the patient gets an answer back. And if your legal asistant is giving out advice, I sure hope your clients are finding another lawyer.

  • Anonymous

    You don’t read too good, do yuh, doc? I said IF my legal assistant gave out legal advice, which s/he does not do, NOR does my receptionist — quite unlike at my doctor’s office, where the receptionist there (as in many other practices, as you can note in many responses to this blog) is the one who wants to know my symptoms, and decides how sick I am, and then decides whether I get 3.5 minutes with The Doctor this week or next month. Which is just about as comical as the summary of my ‘complaint’ the nurse writes on the chart before The Doctor comes in — and which bears no actual resemblance to what I said. Go back up to the top of this thread: it’s all about the failure of doctors to pay attention to their patients and communicate with them. Did any of this thread make an impression on you that something’s rotten in Denmark?

  • ismd

    Anomn 3:46,

    “quite unlike at my doctor’s office, where the receptionist there (as in many other practices, as you can note in many responses to this blog) is the one who wants to know my symptoms, and decides how sick I am, and then decides whether I get 3.5 minutes with The Doctor this week or next month.”

    Then you need to change doctors or be more insistent if you’re really sick. In my office practice, if a patient asks to be seen soon or even that day, that request is run by the physician, who makes the decision.
    And by the way, making appointments for sick visits in no way translates to giving advice over the phone.

    In your earlier comment, you said “my legal assistant would give out much better legal advice than my doctor’s receptionist’s medical advice”. I can read, genius. All I did was say, that analogous to physician office staff, any office assistant giving out advice should be fired and the client/patient change offices.

  • ismd

    “The only problem with all this is that you offer no solutions other than caps (which don’t work) that has a chance of getting through a legislative body or is constitutional.”

    Really? Specialty courts are possibly unconstitutional? Then why do we have workmens comp courts? Tightening requirements for expert witnesses is unconstitutional? I don’t think so. But my rights wouldn’t be violated if, God forbid, I were a defendant in a case in which someone from another specialty gave testimony about pulmonary care?

    “And in exchange for all this immunity you want from patients”

    Read this loud and clear – WE HAVE NEVER ASKED FOR IMMUNITY FROM PATIENTS!! What we have asked for is fairness in the system, including trials that happen in a timely fashion, appropriate expert witnesses, and the like. What we also ask for, FOR THE PATIENT, is they receive their fair share of any monetary award in a timely fashion, which of course would mean limiting the potential millions that can be won by a trial atorney.

    “I think you just haven’t thought about this issue”

    Oh, please.

    “Do you not think a lifetime of pain and suffering has value?”

    Again, even YOU have agreed that there is no way to calculate what pain and suffering are worth. So, using your example of the potential NFL star in a hypothetical case of a leg fracture not being set right, thus ruining a career, he would receive all potential lost wages and all medical care, etc. But how much is the “pain and suffering” of not playing in the NFL worth? A million? 100 million? The total of our trade deficit? No amount would make anyone happy, CJD, so why justify astronomical awards? The only ones who walk away happy are the winning attornies, who stand to receive 40% or more of the award, plus expenses, leaving the NFL player with less than half the award. If you are truly interested in compensation for pain and suffering, then the lawyers should give the bulk of the money to the patient.

    “Don’t try and distance yourself from them now.”

    I’m not. Again, caps keep coming up because you and your ilk bring them up IN THESE COMMENTS. Read what I said. I support caps as PART of a solution to the problem.

  • Anonymous

    “Really? Specialty courts are possibly unconstitutional? Then why do we have workmens comp courts?”

    Workmen’s comp is a statutory scheme not based in common law. Negligence and medical malpractice are, and thus are protected by the US Constitution and many state constitutions. Funny how the founders thought the right to trial by jury had some importance.

    “Tightening requirements for expert witnesses is unconstitutional? I don’t think so.”

    Do you even know the current requirements? What steps would you take to “tighten” them?

    “What we have asked for is fairness in the system, including trials that happen in a timely fashion, appropriate expert witnesses, and the like.”

    Your problem is that you can’t show this isn’t happening. Your trials are no less timely than any other civil trial, and you win 75% of the time. You have no idea what percentage of expert testimony is “false” or “misleading” and you think any that exists is all on one side. You hear this story and that story from your AMA newsletter and think you have it figured out. That’s like putting a moratorium on driving because you heard about some wrecks.

    “What we also ask for, FOR THE PATIENT, is they receive their fair share of any monetary award in a timely fashion, which of course would mean limiting the potential millions that can be won by a trial atorney.”

    The plaintiff’s attorney doesn’t win anything unless they win the case for the plaintiff. If you’re so worried about the plaintiff getting money in a timely fashion, why aren’t you encouraging the insurers to settle quicker? Why do physicians clam up when they do something wrong? Your actions speak louder than your words.

    “No amount would make anyone happy, CJD, so why justify astronomical awards?”

    The first clause of that is not true, but let’s talk “astronomical awards”. How many are “astronomical” in your opinion? Is there a magic number? Are you mad about compensatory awards or punitives? Are we just talking med mal or all cases? Seriously, enlighten me on how you determine what is and isn’t a proper award. Because I can’t think of a better way than letting 12 people hear the evidence from both sides and make a decision on the value. And again, we all admit it’s not perfect, but I think we can all agree the quality of one’s life has value, can’t we?

    “The only ones who walk away happy are the winning attornies, who stand to receive 40% or more of the award, plus expenses, leaving the NFL player with less than half the award.”

    You mean the victim isn’t happy? Considering he/she started with nothing offered and put up no money to fund the case, how are they not happy? And I don’t know how you figure less than half on a multimillion dollar award. Before they hired the attorney, what did they have? Mounting medical bills, a lifetime of pain, mounting mortgage, car, utility bills, etc. You weren’t going to pay those out of your pocket were you? Didn’t think so. Why is it you always forget about the victim’s plight in this?

    “Again, caps keep coming up because you and your ilk bring them up IN THESE COMMENTS. Read what I said. I support caps as PART of a solution to the problem.”

    That’s nice that you say that, but again, actions speak louder than words. And the only legislative action that goes anywhere has caps as a centerpiece. Why? Because it’s the only thing the insurers will back you on. Caps as any part of the solution only hurts those already hurt the worst. So even as PART of the solution, it’s shameful.

    CJD

  • ismd

    “Funny how the founders thought the right to trial by jury had some importance.”

    As long as it’s justified, CJD, and not some bogus piece of bullshit. And the way the system is gamed right now, alot of bullshit cases that shouldn’t be there go to trial. Maybe that’s why we win 75% of the time, and that doesn’t count the claims that never get to trial. I’m sure the founding fathers never meant for crap cases to go to trial. And maybe that’s why it takes so long for justified cases to go to trial.

    “Do you even know the current requirements”

    I sure do, for the state of NJ. The legislature (yep – you know those guys who would never pass that as a law?) has at least made an attempt to tighten up the qualifications for expert witnesses, including being in the same specialty, though it leaves alot to be desired.

    “Why is it you always forget about the victim’s plight in this?”

    Do you read a damn thing that I write, or do you just go off on some emotional and dramatic tangent (such as “Mounting medical bills, a lifetime of pain, mounting mortgage, car, utility bills, etc. You weren’t going to pay those out of your pocket were you?”) to ignore what I said? Let me repeat – we want justice for the patient as much as you do. So we ask for speedy payments to the patients, which doesn’t happen, and more of the money going to the patient. Read the statistics, genius. You know as well as I do that patients get around half, if that much, after legal fees and expenses are paid. But you’d like to ignore that fact, wouldn’t you?

    “Because it’s the only thing the insurers will back you on.”

    We are not insurance company shills, despite your shrill claims to the contrary. While they may support caps, however, they do support all the other measures I’ve discussed. And why shouldn’t they, when their financial solvency can be threatened? And why shouldn’t I support these measures (NOT the insurance company) when my own financial solvency, at least in NJ, can be threatened?

    “Caps as any part of the solution only hurts those already hurt the worst. So even as PART of the solution, it’s shameful.”

    Wrong, wrong, wrong. How do they hurt the patient? How? Because they may get $350,000 (as in the new Wisconsin law which was vetoed) as opposed to a million? Or 75 million as in a recent NJ case? You haven’t said a damn thing to support your statement, other than to try to get an emotional response from the reader.

  • Anonymous

    Here’s the thing ismd, you can make all the “bogus case” claims you want, but you’ve got no facts to back them up. Sure, you can probably find a case here or there, just as I can probably find a case here and there where a defendant denied paying on a legit case. Neither of us has statistical proof of our claims of a majority being bogus or legit. But the burden is on you, since you’re the one who wants to change the Constitution. And it’s a burden you can’t meet.

    “I sure do, for the state of NJ.”

    Really? What’s the standard for admissability of expert testimony in NJ?

    You talk about speedier payment for the patients, but what do you do to promote that? What bill has been introduced in any legislature that pushes speedier payment of legit claims? I look forward to your answer.

    “You know as well as I do that patients get around half, if that much, after legal fees and expenses are paid.”

    Depends on the case. On tried cases, you’re close. But you’re also misreading the statistics. Because usually when someone says “of the total amount spend, only X% goes to the victim”, they are including the defense costs, including administrative costs, in there as well.

    “We are not insurance company shills, despite your shrill claims to the contrary.”

    Sorry, but the facts undermine you here. The only reason we are having this discussion is because your insurance rates went up and the insurers told you it was due to judgments. When insurance rates are flat (not coincidentally when the economy is strong) we don’t hear a peep. Then, when the economy tanked and insurers realized they were underpricing their product and raised rates, here come the cries of the end of medicine.

    Yet the vast majority of physicians know literally nothing about how much their insurer pays its execs, how they set rates, what their payouts are, their historical profitability, their investments, etc. You just hear “the lawyers did it” and next thing you know you’re marching on state capitols.

    Look at you, you still believe in caps. States with and without caps experienced rate increases and lost insurers during the last economic downturn, just as they did in the two previous “crises”. The insurers make literally no promises as to your rates if you enact caps. You have no guarantee from them how much your rates will go down nor for how long. The only guarantee is that those with the worst injuries and no economic damages, ie. the most vulnerable members of society, will suffer.

    Your financial solvency isn’t at risk. How many insured physicians have ever gone bankrupt solely due to judgments? Do you even have a number?

    How do caps hurt the patient? Let me give you an example. Your child (assuming you have one) is the victim of malpractice. He is rendered a paraplegic. You get your economic damages in the form of past and future (estimated) medical bills – which all go to third parties ultimately. He has no economic damages because he’s not got a job and trying to guess what he’d earn is too speculative to be evidence. So now he gets $350,000, and usually that’s not indexed for inflation, so if he’s injured in a few years it’s worth even less. $350,000 for a lifetime of being a paraplegic. You’ve just valued his quality of life at about what a surgeon makes in a year.

    Are you really telling me that’s justice? Someone else’s actions caused this, and that’s justice? Sure it’s an emotional subject, but any case with a significant level of pain and suffering damages is going to be emotional.

    Look, I think you’re a well intentioned guy, but you just haven’t looked at the issue deeply enough. I bet you do want to compensate more victims more quickly. But the fact is the real backers of tort reform, insurers, aren’t in the business of paying out more money. Thus your well intentioned pleas are going nowhere.

    I’d love to discuss a different system with you if it were even on the horizon. But it’s not, so forgive me if I don’t choose to indulge you. The only thing on the horizon is universal health care, which will render all of this moot. If physicians don’t start focusing less on lawyers and more on how the whole game is funded, none of this will matter.

    And really, the whole “lawyers don’t care about their clients they just want the money” schtick grows tiresome coming from physicians. After all, we wouldn’t be having this discussion if your own wallets hadn’t been lightened by an increase in insurance rates.

    CJD

  • ismd

    “when the economy tanked and insurers realized they were underpricing their product and raised rates”

    Again, the same tired old attorney line about why malpractice rates went up with absolutely no facts to support the claim.

    “Look at you, you still believe in caps. States with and without caps experienced rate increases and lost insurers during the last economic downturn, just as they did in the two previous “crises”.”

    Yep – I still believe in caps as PART OF THE SOLUTION, not the whole solution. And, while rates may not go down immediately in staes that enact caps, due to cases still waiting to be heard, they eventually do go down. Please don’t quote the discredited Weiss Report. And again, you resort to emotion, not fact, with your comment “The only guarantee is that those with the worst injuries and no economic damages, ie. the most vulnerable members of society, will suffer.” Give us the facts!

    And if my child were rendered paraplegic, God forbid, no amount of money in the world would make a difference to pacify myself and my family, not a 100 million or even more. It wouldn’t make him move again, or cure his paraplegia. And, yes I’d be angry, don’t even doubt that. But justice will have been served, and my child would be supported. Guess I’m just not a vengeful guy.

    “Look, I think you’re a well intentioned guy, but you just haven’t looked at the issue deeply enough.”

    Oh, please, I’ve looked at this backwards and forwards, and because we choose to disagree doesn’t mean I haven’t looked at any of the issues. Because I don’t agree with you doesn’t mean I’m an insurance company shill, or that I don’t give a damn about patients.

    “After all, we wouldn’t be having this discussion if your own wallets hadn’t been lightened by an increase in insurance rates.”

    Or if attorney wallets weren’t threatened by tort reform.

    End of discussion.

  • Anonymous

    “Again, the same tired old attorney line about why malpractice rates went up with absolutely no facts to support the claim.”

    I’ve cited you to articles from Medical Economics magazine, to Warren Buffett’s explanation about insurance, to statements by the INSURERS themselves. What else do you want?

    ” And, while rates may not go down immediately in staes that enact caps, due to cases still waiting to be heard, they eventually do go down.”

    This is simply not true. And you can point to literally no evidence to back this statement up. Rates go up and down with the economy in states with and without caps. But by and large, they trend up as medical inflation trends up. Why with medical inflation? Because awards are tied in large part to medical bills, both past and future. Even the most cursory look at the issue shows that. Look at each of the three “crises” in the last 30 years and look at what happened to the US economy at the same time.

    “”The only guarantee is that those with the worst injuries and no economic damages, ie. the most vulnerable members of society, will suffer.” Give us the facts!”

    The fact is obvious. A small injury where the victim fully recovers isn’t likely to result in a high pain and suffering award. High pain and suffering awards come with major injuries. As to the weakest members of society, that is financially most vulnerable, ie. children, stay at home moms, and the elderly. They have NO ECONOMIC DAMAGES other than medical bills, which will go to third parties. What about those facts don’t you understand?

    ” And, yes I’d be angry, don’t even doubt that. But justice will have been served, and my child would be supported.”

    How would your child be supported? By you? Let’s assume someone isn’t as well off as you or something happens to you. Where does the support come from? Again, your child HAS NO LOST WAGES. His only recovery is future medical bills. Incidentally, who are you going to get to represent your child if the doctor denies liability? An insurance defense attorney?

    And I think you do give a damn about patients, and are very well meaning. I just don’t think you realize that the only guaranteed beneficiaries from tort reform are insurers. And when you back it, that’s who you’re going to bat for. Intentionally or not.

    CJD