An old-timer bemoans the demise of the physical exam, or hyposkillia:
We need teachers who truly comprehend the value of a good medical history, the rewards of a pertinent physical examination, the power of knowing how to think, and the importance of accountability; teachers who first use the stethoscope, not an echocardiogram, to detect valvular heart disease; teachers who first use the ophthalmoscope, not magnetic resonance imaging, to detect intracranial hypertension; teachers who first use their eyes, not a blood gas apparatus, to detect cyanosis; teachers who first use their hands, not computed tomography, to detect splenomegaly; and teachers who always use their brains and their hearts, not a horde of consultants, to manage their patients.We need teachers who don’t order expensive, state-of-the-art studies when cheaper, conventional tests supply the same information; teachers who don’t administer a slew of medications in an effort to alleviate every possible ill; teachers who appreciate that doing nothing is, at times, doing a lot; and teachers who realize that many patients get well despite what we do, not because of what we do.
Those days are long over, my friend. Readers of this blog know why this is happening: time pressures in a fee-for-service reimbursement system and defensive, objective-based medicine.
I recently discussed this with someone who is completely unapologetic about the demise of old-school, physical exam-based medicine: “I compare it to this – why travel by horse and buggy when you have a car available? The same goes for today’s medicine.” (via Notes from Dr. RW)
Update:
retired doc comments.
Update 2:
Dr. RW addresses some of the comments here.
Related posts:
- The privilege of being at a patient’s bedside
- Rounding by robot
- Are doctors finding the physical exam useless and obsolete?
- The neck
- The pharynx
- "Why listen when you can order a scan?"
- Old-school doctors
{ 71 comments }
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“Basically this is the reason why medicine is loosing respect I think.”
Yes, I’m sure the ridiculous levels of arrogance by the anonymous posters has nothing to do with it. The thing is though, that’s probably not even the real reason why. The real reason is likely due to the fact that medicine is not viewed as a right by most voters. Thus, you’re nothing more than highly skilled civil servants, another govt. bureacracy to be endured.
“especially the trial lawyer variety and most of them don’t bite the hand that cares for them.”
And yet everyone, including and especially doctors, run to the trial lawyers when things don’t go their way. Strange, huh?
“No judge will admit a blog like this as evidence, unless you’ve heavily campaigned for his/her election.”
Yes, because no emails have ever made it into evidence, eh Mr. Skilling?
“Even if it is there it is supposed to be interpreted by a group of my peers who are active and informed.”
Your arrogance has caused you to misconstrue the meaning of the word peers in this context.
What’s more, your knowledge of the Vioxx facts is quite poor, which is surprising considering the way you denigrate the jurors. It was not the same lawyers at all who tried the second case. It’s also impressive how you could take two completely separate cases, both with weeks of testimony each, and distill the difference down to the education of the jurors, people you’ve never met. Do mind reading skills come with a medical degree?
“The real reason is likely due to the fact that medicine is not viewed as a right by most voters. Thus, you’re nothing more than highly skilled civil servants, another govt. ‘bureacracy’ to be endured.”
interesting theory. Doctors work for Government insurance program, private HMOs or as a fulltime salaried employee or a lot others. Sometimes they may act as an extension of the government and the bureaucracy, So are a lot of other people with other profession. Hardly makes a civil servant out of anybody. And the people who views health care as their right,i.ve found them most litigious . Health is never a right, can’t be given to any body. It is an asset that has to be earned and maintained .period. There is no element of truth in your assertion.
“And yet everyone, including and especially doctors, run to the trial lawyers when things don’t go their way. Strange, huh?”
The prevailing culture of victim hood and entitlement hits everone .Doctors are no exception. That being said the fundamental question is Even if I hire a hit man for my purpose (doesn’t make me a saint) how much I can trust him and given a questionnaire will rate him for professional work, even though he may be pretty good in his job
“Your arrogance has caused you to misconstrue the meaning of the word peers in this context.”
Enlighten me. And face some more arrogant music (if you think it is.)
“Considering the way you denigrate the jurors”
It is denigration, are you so thin-skinned? If I had to endure rambling of a Harvard physicist on nanotechnology and nanorobots not for fun but to remember and second-guess later when I find another scientist holding much different opinion and I’m between Scylla and charybdis .”Whom to believe to pass the judgment” I ask from my yawning mouth”
If anybody tells me that I did a lousy job does it denigrate me as I am a doctor? No my education has not empowered me in that way let’s face the truth. But I see a lawyer so eager to put me in the jury pool. If you can’t convince him better confuse him. Who denigrates me more? Jury system as the way it is, will spark discussion and criticism time to time. Let’s not make it a holy cow.
“It was not the same lawyers at all who tried the second case”
And I thought justice is done on the merits of the case not how clever the lawyer was .By the way are you denigrating Chris Seegar ?
“It’s also impressive how you could take two completely separate cases, both with weeks of testimony each, and distill the difference down to the education of the jurors, people you’ve never met”
The final nail for Merck’s coffin was those dubious emails and internal documents so vocipherously crowed by Lanier in the 1st trial .Seegar took the same path and got slapped. Hardly it takes time to know the thought process of a person,even you’ve not met him if some one could lap up their identities and statements. Just needed a little googling. How the juries of the 2nd trial felt and issued their statement was avoided by the ATLA website like a flea infested mongrel ,even when you see those of the 1st case burning bright. Do mind you are the only one with internet connection?
“Health is never a right, can’t be given to any body. It is an asset that has to be earned and maintained .period. There is no element of truth in your assertion.”
Don’t kid yourself. With the nations largest and most wealthy voting bloc now becoming the biggest consumers of healthcare, it’ll be a right before the end of this decade. Not health, healthCARE.
“Even if I hire a hit man for my purpose (doesn’t make me a saint) how much I can trust him and given a questionnaire will rate him for professional work, even though he may be pretty good in his job”
Why would you trust a doctor for the same reasons?
“Enlighten me.”
Do your own constitutional law research.
“Jury system as the way it is, will spark discussion and criticism time to time. Let’s not make it a holy cow.”
I agree wholeheartedly. What I’m referring to is the belief by physicians that they should not have to be judged by anyone but others with a medical degree and the belief that jurors are simpletons who are all easily swayed by emotional pleas.
” Just needed a little googling.”
Yes, because a few quotes in the Wall Street Journal are representative of the evidence of an entire trial, involving two different plaintiffs, with two different medical histories, who took Vioxx for different lengths of time.
Considering the amount of complaining physicians do about how the media reports medical issues, it’s amazing the faith you have in its ability to accurately report legal ones. You hear what you want to hear, I guess.
Can I accurately assess your intelligence based on what you’ve written here, which is far more voluminous than any quotes from the Vioxx jurors?
CJD
“With the nation’s largest and most wealthy voting bloc now becoming the biggest consumers of healthcare, it’ll be a right before the end of this decade”
Does it make it more dangerous or less dangerous, only time will tell. But as an advocate of a free market economy I think we should have choice where I can sell my craft. Be it NHS or Canada style it will bring their own share of woes. It will be over simplistic to hop to the other side of the fence. Having said that, it was my person opinion in context to challenge someone else’s false belief.
“Why would you trust a doctor for the same reasons?”
People usually don’t bite the hand that cares for them but some of them have their dentures borrowed from a lawyer- could be another lawyer joke. Going to post on lawyer stink
“belief by physicians that they should not have to be judged by anyone but others with a medical degree and the belief that jurors are simpletons who are all easily swayed by emotional pleas.”
Not everyone can judge scientific evidence. I can’t judge evidence on astrophysics but can if it is a C+ programme. I know my limitations so everybody should. After the heavy battle of the expert witness is over, refuting each other what else a jury member can do, not to respond to a Broadway tearjerker. Probably I would have done the same thing.
“It’s amazing the faith you have in its ability to accurately report legal ones”
Conscientious issues like law is subject to more introspection and second guessing because it is not science in the first hand , much more ethics logic and philosophy kind where people can talk and talk and nothing comes out. So the opinion gets polarized based on the career political belief and ideologies. But that is what law is.
Even the mostly hot debated issue in Medicine is not the steps of Lap chole but of legal medicine. So which legal reporting I can believe. If I refute vioxx 1 why not 2 or 3 or vice versa why cant there be a court TV like thing for tort cases as the drama here is no less now a days, because there is so much money involved
“Can I accurately assess your intelligence based on what you’ve written here, which is far more voluminous than any quotes from the Vioxx jurors?”
You can’t, but can see how the thought process operates which is only a fraction of the total intelligence
“Because a few quotes in the Wall Street Journal are representative of the evidence of an entire trial”
Call it evidence. I call it bottom-line to see what went in their mind .what comes out of their mouth,if it was’nt doctored, is a glimpse of that and that is what a trial is all about.
“After the heavy battle of the expert witness is over, refuting each other what else a jury member can do, not to respond to a Broadway tearjerker. “
And yet the physician wins 75% of the time. Maybe they are just more strong willed than you are, and less prone to being swayed by emotion?
“Conscientious issues like law is subject to more introspection and second guessing because it is not science in the first hand , much more ethics logic and philosophy kind where people can talk and talk and nothing comes out.”
I think you should watch a trial sometime. A trial is not like a debate class where attorneys just get up and muse on various subjects.
“You can’t, but can see how the thought process operates which is only a fraction of the total intelligence”
It’s stunning to me that one would think they can understand a person based on a couple of sentences. I think you’re illustrating where a medical education falls short in understanding others.
“Call it evidence. I call it bottom-line to see what went in their mind .what comes out of their mouth,if it was’nt doctored, is a glimpse of that and that is what a trial is all about.”
I can’t imagine that the Journal, with its decidedly pro-limited liability for corporation stance, would take a portion of a quote to make a point, can you? I read the Journal every day, and enjoy it immensely, but even when I agree with them I retain my skepticism.
CJD
Remember OJ CJD?
This is the FACT. the molecular biology PROVED his blood was at the scene of the crime which means one of two things
1: He did it
2: There was a massive conspiracy by the LAPD to set up OJ
We know what the jury went for. You know better than I WHO you pick for a jury. Quit the BS.
“And yet the physician wins 75% of the time. Maybe they are just more strong willed than you are”
Are you pointing to that fraction? Which shouldn’t be there in the first place . Doctors will win those any way. Despite the treacherous character of a trial. You try those as a jackpot and sometimes prove yourself a jackass.
“Trial is not like a debate class where attorneys just get up and muse on various subjects”
Then what it is any way .Attorney does get up, not as often, and muse. In fact they muse everywhere in front and behind the camera in front and back of their client, the judge and juries .they are trained to muse and confuse. Why shouldn’t they.
“I can’t imagine that the Journal, with its decidedly pro-limited liability for corporation stance, would take a portion of a quote to make a point”
And you imagine an organization like ATLA or CJD or lots of phony others, with their “pro trial lawyer pocket stance “won’t make a point with their share of quotes. They do. It is up to me to analyze those with the jurors’ background.
“We know what the jury went for. You know better than I WHO you pick for a jury. Quit the BS.”
Obviously, one jury is representative of the thousands of juries that hear cases every day across the country. Just like one physician is representative of the thousands of physicians across the country, right?
Excellent analysis.
“Despite the treacherous character of a trial. You try those as a jackpot and sometimes prove yourself a jackass.”
I’m curious, how many trials have you observed?
“Attorney does get up, not as often, and muse. In fact they muse everywhere in front and behind the camera in front and back of their client, the judge and juries .they are trained to muse and confuse. Why shouldn’t they.”
You’re right – it’s just like on TV. Same as medicine. I surrender to your superior experience.
“And you imagine an organization like ATLA or CJD or lots of phony others, with their “pro trial lawyer pocket stance “won’t make a point with their share of quotes.”
That’s why I don’t cite ATLA as my source for anything.
“It is up to me to analyze those with the jurors’ background.”
God, is that you? Nope, just another physician with a god-complex.
“You’re right – it’s just like on TV. Same as medicine. I surrender to your superior experience”
I think you don’t experience publicity whores babbling on TV to call them for making a fortune. in contrast to those histrionics. Law and order or, Boston legal is a nice watch. Are you pointing to those? A similar thing in Medicine would have been an angelic Santa Claus like Doctor with a Magic Wand in hand promising cure for any Disease – Come to me, see how the road to secret garden opens for you. I scratch my head No I haven’t seen. Any way I’ve seen lots of ‘ER’ or ‘Chicago Hope’
“God, is that you? Nope, just another physician with a god-complex.”
Then we are a nation of GODS .Everyone should have the right to think in their way. Because I don’t take your argument lying down, I’ve God complex. Are you just another lawyer with unbridled chutzpah?
No, you have a God complex because you believe you can accurately assess the intelligence and reasoning of a person based on a couple of sentences in a newspaper article. The chutzpah is yours, my friend.
You’re right though, physicians don’t advertise. The insurers and hospitals supply their customers and reward them handsomely – one of the upsides of not being part of the free market. Surely you’re not going to tell me that hospitals don’t advertise, are you? Or that insurers don’t?
And scratch your head no more, my friend:
http://abc.go.com/primetime/miracleworkers/
“The insurers and hospitals supply their customers and reward them handsomely – one of the upsides of not being part of the free market”
Free market is nostalgia for a physician who could charge the way he/she liked and let the market decide that. They are presently tied with rims of paperwork to satisfy a faceless bureaucrat; their reimbursements are slashed and go down year after year and with no leverage for negotiation. If this your handsome reward and the idea of free market for a physician is, Adam Smith must be spinning in his grave.
Efficiencies of a free-market is well-known and if it works in any sphere so it is medicine, so is law . The problem, however, is that unlike computer industry or the health care industry government mandates the existence of your legal industry. That’s why it neither has competition, nor fear of drying up and go away.
For starters, there is little benefit to your legal industry to ensure that rewards- which, again, are supposed to make things even, actually find their way to victims. You can debate the specific numbers all day long- amount of work involved in bringing a case,where real dollars actually split in real cases, and the reasoning behind all of these things. The end result is that there is no way for
a victim to resolve legal conflicts and get justice other than using the lawyers,now so much of them, and the industry itself can only sustain itself
with money not paid to victims.
This imbalance, in turn, causes law to be used as a weapon- a first line of defense- more often than a last-resort reaction
In addition one of the dirty little secrets of the American legal system is that anyone who feels wronged, or wants to feel wronged, for any reason, is protected from any risks you might think exist in bringing a lawsuit against another individual or company.
So considering our ‘nation of victims’, there are very few situations in which a particularly vengeful person can’t find something to sue for. Sure, such cases may be thrown out fairly quickly- but that’s not the point. The point is you vindicated yourself by forcing your ‘enemy’ to part with quite a bit of money. It’s a scary amount of unchecked power the average citizen has – this is not free market
If it is that impossible for our legal system to operate not as a money-making industry, but somehow outside of the free market, then the next-best solution would be to “check” it with the risks and rewards of the free market itself.
In a sense legal industry could be seen as an industry with standard “no risk, money back guarantee.” marketing practice The only differentiator here is who sues who- you only get the no risk guarantee if you decide to sue first Are we just inspiring people to be victims and file suits over more risky free-market based methods This notion that a losing plaintiff never has to pay flies in the face of the entire concept of a justice procedure which supposedly can
assess a monetary loss caused by any action, and if necessary, require an offending party to compensate the “victimized” party for that loss.
If someone cannot possibly stamp a physician or any body a victim of a wrongful lawsuit- which is essentially what the legal system is saying- then how can we consider people who suffer property damage, damage to a reputation, or other such things victims who deserve retribution? What is the difference?
If you ever want the legal system to play in the free market, then the only way to ensure its done fairly is if the same concepts of shared risk are allowed to remain. Bring a lawsuit, be prepared to suffer the consequences of, frankly, wasting everyone’s time.
See how talking about free market opens up your can of worms.
“Free market is nostalgia for a physician who could charge the way he/she liked and let the market decide that. They are presently tied with rims of paperwork to satisfy a faceless bureaucrat; their reimbursements are slashed and go down year after year and with no leverage for negotiation.”
And yet physicians are doing it already – plenty of blogs on the subject. If you aren’t, it’s because you choose not to.
” The end result is that there is no way for a victim to resolve legal conflicts and get justice other than using the lawyers,now so much of them, and the industry itself can only sustain itself
with money not paid to victims.”
If you can think of a cheaper way to get responsible parties to pay for their damages, I’d love to hear it. All services cost money, including legal services.
“In addition one of the dirty little secrets of the American legal system is that anyone who feels wronged, or wants to feel wronged, for any reason, is protected from any risks you might think exist in bringing a lawsuit against another individual or company.”
This statement lacks a factual basis.
“It’s a scary amount of unchecked power the average citizen has – this is not free market”
The power of the individual citizen is what defines the free market, my friend.
“This notion that a losing plaintiff never has to pay flies in the face of the entire concept of a justice procedure which supposedly can assess a monetary loss caused by any action, and if necessary, require an offending party to compensate the “victimized” party for that loss.”
Ahh, I see the problem – you don’t understand the economics of the plaintiff’s case – someone does pay – namely the lawyer. And in business torts, the plaintiff themselves. So it is not by any stretch of the imagination (beyond small claims court) a free shot. What’s more, almost every state does have a version of loser pays.
The other problem with your logic is that we have already paid for the defense in the terms of premiums for our insurance. The insurer understood this risk and weighed it against the profit potential of utilizing your premium in the interim when it set the price and collected your money.
Most of the awards in law, be it contracts, tort, individual or corporate parties, are about burden shifting. Rarely is their a net benefit. Take your average malpractice case – the bulk of the award ends up in the hands of medical providers or the plaintiff’s insurer. Another large chunk will reimburse the plaintiff for lost wages. These are all costs that would be incurred regardless to society, we are just putting them on the responsible party.
The only can of worms we’ve opened up is an illustration of your lack of knowledge of how the law and the legal system work. Exactly how many trials have you observed? How many cases have you been involved in?
“Plenty of blogs on the subject. If you aren’t, it’s because you choose not to”
These are for venting day to day frustration and have a sense of bonding like another worker in a high-risk job. Leverage for negotiation only comes from lobbying,collective bargaining and lastly the notorious industrial action stance. Physicians are poor in those ‘because they aren’t trained. I don’t see medical schools waking up to reality in near future.
“All services cost money, including legal services.”
And the unique thing is that it is mandated by the government. There is a reason it cost hundreds of thousands of dollars to go to law school. There is a reason our legal statutes are the size of libraries (but constitution is only few pages long). There is a reason very few people actually understand the minutia of most court cases- even those involving simple Subjects.
The complexity of laws and legal proceedings keep lawyers in business. Although I’m not a conspiracy theorist but it seems the whole system was devised to benefit the lawyers, mandated by government. So probably what is needed is a somewhat DEMYSTIFICATION and DE-COMPLEXIFICATION OF LAW
“This statement lacks a factual basis”
What is the downside of bringing the lawsuit for the plaintiff?
“The power of the individual citizen is what defines the free market “
Then common sense tells us that it is to be extended to both the parties in a lawsuit, if fairness isn’t a hollow word. if a rule is allowed to be a precedent, to line some one’s pocket (govt. mandated remember) and making the defendant eat humble pie, is not a free market, if not a scary conspiracy.
“Almost every state does have a version of loser pays”
No state has it in the European style and what is there is an eye wash. And when I’m the defendant and I win I give a shit where your money comes from plaintiffs or lawyers ‘cause you dragged me to court for no reason.
“The other problem with your logic is that we have already paid for the defense in the terms of premiums for our insurance. The insurer understood this risk and weighed it against the profit potential of utilizing your premium in the interim when it set the price and collected your money.”
That big premium came from a physicians sweat and labor and extra hours of work. May be he wouldn’t work that hard or use it for his own (nothing selfish about it) rather than squander it on your whims. Defending even a bogus case cost my insurer money that is passed on everybody, artificially raising premiums. Not with tort reform but with a proper loser pay system premiums can go down significantly
Your can of worms still open.
“Physicians are poor in those ‘because they aren’t trained.”
They don’t have to be trained in it. They simply need to hire the people who are. That’s what every other group does.
“There is a reason it cost hundreds of thousands of dollars to go to law school.”
It doesn’t cost hundreds of thousands at most state schools.
“There is a reason very few people actually understand the minutia of most court cases- even those involving simple Subjects.”
Yeah, because they’ve never read them. How many actual cases on, say, a contracts dispute between a homeowner and builder have you ever read and could not understand? I’d venture to say none, because you’ve never read any. You’re just assuming.
“What is the downside of bringing the lawsuit for the plaintiff?”
Depends on the case. The expense, the time involved, etc. If it’s a contingency fee case, it’s the lawyer who has the downside.
“No state has it in the European style and what is there is an eye wash.”
I bet you can’t even tell me what we have here, much less how it works in Europe. In fact, I’m almost certain that you’ve not looked at one statute from any country in Europe, much less any state in America, which explains it.
“And when I’m the defendant and I win I give a shit where your money comes from plaintiffs or lawyers ‘cause you dragged me to court for no reason.”
Do you really believe every defendant who is sued did absolutely nothing? That literally every case is frivolous? I’m sure those health insurers who were sued by 900,000 physicians would agree with you.
” May be he wouldn’t work that hard or use it for his own (nothing selfish about it) rather than squander it on your whims.”
So if you had loser pays you wouldn’t carry insurance? Do you really believe you are incapable of negligence of any form? Impressive!
“Defending even a bogus case cost my insurer money that is passed on everybody, artificially raising premiums.”
Why is it artificial? Do you not think the insurer analyzed the risk? Do you even know how much your premiums went up as a direct result of that cost? I’d bet you have literally no clue as to how your premiums are determined.
“Your can of worms still open.”
The analogy died a couple of posts ago.
“They don’t have to be trained in it. They simply need to hire the people who are. That’s what every other group does”
Be it physicians themselves or any people they hire, even the idea of lobbying, collective bargaining and not to mention industrial action flies off in the face of the hard core ethics the medical school tries to drill in their students. This imposed altruism is a perfect recipe for disaster .The ivory tower of medical ethics is so high; the sound never reaches the ordinary physician like us. it dies down in the middle. Training is a mindset that medical schools failed to impart in the changing world
That is the point.
“I bet you can’t even tell me what we have here, much less how it works in Europe”
Chutzpah once again. My dear friend just follow this link and educate yourself . It will take a good no. of posts to sum up what is given here.
http://www.overlawyered.com/loser_pays/
“Do you really believe every defendant who is sued did absolutely nothing? That literally every case is frivolous?”
If you believe the jury system then without second-guessing, a person exonerated did absolutely nothing. Out of this A fraction is definitely frivolous.. The suspicion rises when the rate of exoneration is rising up to 75-80 %. To prove it is frivolous a physician has to counter-sue, which are rarely allowed to proceed (I’ve heard only a couple of successful ones), and expenses are not borne by insurance (except by some phony Medical Justice), and no lawyer will work on contingency fee especially against another lawyer. So to legally prove the case was frivolous is more difficult than to prove malpractice.
“So if you had loser pays you wouldn’t carry insurance? Do you really believe you are incapable of negligence of any form? Impressive!”
You’re putting your words in my mouth. Mishaps happen and so there is the insurance .
But these are for compensating actual victims, not for defending false claims Since mistake is inevitable , a rational approach should be to share the burden between Doctors and their patients ,from a common pool . Loser pays doesn’t eliminate insurance, just streamline that and make it realistic.
“Do you not think the insurer analyzed the risk? Do you even know how much your premiums went up as a direct result of that cost?”
If an insurer has to analyze the risk of bogus claims then the gaming of the system is in full swing. It sounds more like Vito Corleoni making an offer the company can’t refuse and will go on coughing out protection money so a crack-pot lawyer can play jackpot
“”Your can of worms still open.”
The analogy died a couple of posts ago”
You buried it ,but the stench is reprehensible
“Be it physicians themselves or any people they hire, even the idea of lobbying, collective bargaining and not to mention industrial action flies off in the face of the hard core ethics the medical school tries to drill in their students.”
Stop the madness with this nonsense. Physicians have no problem hopping into bed with insurance companies to make a buck, or suing them to make another. All the sudden you’ve got an aversion to lobbying for your bottom line? How sweet.
“Chutzpah once again. My dear friend just follow this link and educate yourself . It will take a good no. of posts to sum up what is given here.”
Your link doesn’t explain how the current system of loser pays work. I think I’ve pretty clearly illustrated that you don’t know what you’re talking about on this issue, whether it’s in this country or abroad. I’ll tell you again, though – almost every state in the Union already has a version of loser pays.
But hey, you’ve read Overlawyered so you have the insurer’s position down. You’re halfway to understanding.
“no lawyer will work on contingency fee especially against another lawyer.”
You must be drinking with this statement. I know plenty of lawyers who, if there are sufficient damages, will take a contingency fee case against another lawyer.
“But these are for compensating actual victims, not for defending false claims”
So then a claim must always be false or true, correct? There is no room for honest disagreement on, say, the standard of care? Have you never had a disagreement w/ another physician on proper care?
“a rational approach should be to share the burden between Doctors and their patients ,from a common pool.”
What are you proposing here? A tax on doctors earnings and patients earnings to pay for physicians’ negligence?
“If an insurer has to analyze the risk of bogus claims then the gaming of the system is in full swing.”
I think it’s also pretty clear you have no concept of how insurers work. Seriously, read the Buffett letter to get a start.
“All the sudden you’ve got an aversion to lobbying for your bottom line? How sweet”
Who said so . I am all for it. But many actions that seems quite natural for other people , are not tenable for us ‘cause you lose public support very soon. And it does cause “harm” in the short term. So the answer is still blowing in the wind.
“I’ll tell you again, though – almost every state in the Union already has a version of loser pays.”
Then link me something,
“You must be drinking with this statement. I know plenty of lawyers who, if there are sufficient damages, will take a contingency fee case against another lawyer”
Then all successful physicain will plan a countersuit at the drop of a hat (about 75% of them) . Doesn’t seem to happen.
“There is no room for honest disagreement on, say, the standard of care? Have you never had a disagreement w/ another physician on proper care?”
Oh my God. Those honest disagreeing physicians don’t debate with me in the court room costing my time and money. And if there are so much of honest disagreement
Some Expert witness will agree and some won’t .the plaintiff s lawyer will search for someone to agree. Then we all have honest agreements and disagreements, and medicine will go to hell. If medicine is so subjective a thing, it should have been immune to law suits.
“A tax on doctor’s earnings and patients earnings to pay for physicians’ negligence?”
Why not? if physician is not negligent patient will have his own share and in a case of negligence’ pt would have both. That’s better than applying for medical bankruptcy because this system won’t give a dime, if he can’t prove. You can make it more interesting if some tax from the lawyer’s income can enrich this pool, if they chose to represent the plaintiffs. No contingency fee just standard hourly fees. Difficult, but nonetheless possible.
“I think it’s also pretty clear you have no concept of how insurers work. Seriously, read the Buffett letter to get a start.”
What is that ?
“But many actions that seems quite natural for other people , are not tenable for us ‘cause you lose public support very soon. And it does cause “harm” in the short term.”
What are you talking about? You already have a massive lobbying arm in the AMA, it’s just not very effective. No one is going to lose respect for you if you lobby for higher Medicare reimbursements. You’re already bitching about it incessantly as a profession, what do you have to lose by actually trying to change it?
“Then link me something,”
Do your own research Google any state’s statutes and then search within them for “offer of judgment”. It essentially works like this: A defendant or plaintiff can make an offer, and if the other side rejects the offer and continues with the case and the ultimate verdict is not within x% of the offer, either high side or low side depending on the party, then the party who offered pays the costs.
“Then all successful physicain will plan a countersuit at the drop of a hat (about 75% of them).”
You’re equating a losing case with a frivolous case. Every case has a loser, but that doesn’t mean every case is frivolous.
“the plaintiff s lawyer will search for someone to agree.”
And you know this from your extensive experience within a law office? Have you ever even spoken with a plaintiff’s lawyer regarding how they select their cases? Or are you reading minds?
“Difficult, but nonetheless possible.”
Absolutely – so propose it legislatively.
“What is that ?”
Berkshirehathaway.com. Letter to Shareholders, February ‘05. Insurance part starts on about 3rd page I think.
No pun Intended Frankly anonymous you seem quite nice to me. Are you a woman ?
Ahh the anonymice must be CJD lite
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