Matthew Holt is sad about the obsession with malpractice

He laments:

People, malpractice is one percent of the dollars, and it’s about 17th on the list of major health care problems and issues we face in this country! It’s the abortion issue of health care – polarizing way way beyond it’s importance.

Deal with it. With 40 percent of malpractice cases being baseless, there is certainly reason for the obsession with malpractice. When physicians let the threat of lawsuits affect clinical decision making, it’s a problem. And yes, that is what’s happening.

BTW, I never quite understood how people can interpret this study as anything but support for malpractice reform – unless they were elated with the 40 percent error rate.

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  • Anonymous

    “BTW, I never quite understood how people can interpret this study as anything but support for malpractice reform – unless they were elated with the 40 percent error rate.”

    Probably because that’s not at all what the study concluded, and because literally nothing in the reforms currently before Congress would change that even if it were true.

  • Anonymous

    Kevin, while you’re certainly prone to spin on this issue, your misstatements are normally not so, shall we say, obviously wrong.

    What’s the deal here? Are you angry because the report didn’t say what you thought it would?

  • Anonymous

    Yet another study that belies many of physicians’ claims:

    http://www.healthaffairs.org/press/mayjune0603.htm

  • Aggravated DocSurg

    I think what Mr. Holt fails to understand is that malpractice is not “1% of the health care dollars” when it comes to providers — it is a major, major outlay of money, in terms of malpractice insurance costs, litigation costs, time away from practice costs, etc. As well, the nebulous “defensive medicine” that is practiced, admittedly hard to define, represents I suspect far more than the 1% of costs Mr. Holt attributes to this issue.

  • Anonymous

    ” it is a major, major outlay of money, in terms of malpractice insurance costs, litigation costs, time away from practice costs, etc.”

    On average, malpractice premiums are less than 10% of a physicians’ overhead. Litigation costs are borne by the insurer.

    As for time away from practice, if all the physicians surrounding Mr. Frist the other day have time to take off for that, surely they can spare a few hours because their insurer won’t settle a case. Of course, the likelihood of a physician ever seeing the inside of a courtroom is infinitesimally small, considering how many cases are settled before trial.

    Even if the number were 10%, it still receives an indordinate amount of attention from physicians. Particularly considering the return they get from most reform proposals.

  • Anonymous

    Question for CJD or others. What makes a good plaintiff lawyer? Is it the percentage of cases that are not dismissed (ie. baseless), the percentage of cases that are actually won, or is it just the dollar figure minus expenses that is brought into the firm?? I am just curious how you rank each other. Don’t feed me the line you are really trying to help them. With a 40% false negetive rate you are not helping many people. That is even with you saying you wouldn’t expend capital on a meritless, non-winnable case.

    Of course I am being a bit sarcastic but I am seriously curious about the question. I could give an opinion on who I think are good doctors based on their competence, complication rates, patient outcomes and satisfaction, etc.. What do you consider makes a good plaintiff lawyer? You can’t defend them all, just like I can’t defend all doctors, especially when you can get a cracker jack law degree on-line.

  • Anonymous

    Notice the hyprocrisy of the physician’s position. On one hand, they wax poetic about all their schooling makes what they do so incomprehensible to the layperson and makes them so desrving of respect and deference.

    On the other hand, they complain when injured laypeople–who inevitably have incomplete information about their treatment–have a high error rate.

    Can’t have it both ways, guys.

  • Anonymous

    “What makes a good plaintiff lawyer? Is it the percentage of cases that are not dismissed (ie. baseless), the percentage of cases that are actually won, or is it just the dollar figure minus expenses that is brought into the firm??”

    From whose perspective? The clients? Or as one attorney hiring another?

    “With a 40% false negetive rate you are not helping many people.”

    You didn’t really read the author’s opinions on the study, did you? You should. There is no 40% false negative rate.

  • Anonymous

    40% baseless, the others will argue whether a medical mistake directly led to the bad out come.

    Answer the question from both viewpoints if you want.

  • Anonymous

    Straight from the studies’ conclusions:

    “Our findings point toward two general conclusions. One is that portraits of a malpractice system that is stricken with frivolous litigation are overblown. Although one third of the claims we examined did not involve errors, most of these went unpaid. The costs of defending against them were not trivial. Nevertheless, eliminating the claims that did not involve errors would have decreased the direct system costs by no more than 13 percent (excluding close calls) to 16 percent (including close calls). In other words, disputing and paying for errors account for the lion’s share of malpractice costs. A second conclusion is that the malpractice system performs reasonably well in its function of separating claims without merit from those with merit and compensating the latter. In a sense, our findings lend support to this view: three quarters of the litigation outcomes were concordant with the merits of the claim.

    However, both of these general conclusions obscure several troubling aspects of the system’s performance. Although the number of claims without merit that resulted in compensation was fairly small, the converse form of inaccuracy — claims associated with error and injury that did not result in compensation — was substantially more common. One in six claims involved errors and received no payment. The plaintiffs behind such unrequited claims must shoulder the substantial economic and noneconomic burdens that flow from preventable injury.33,34 Moreover, failure to pay claims involving error adds to a larger phenomenon of underpayment generated by the vast number of negligent injuries that never surface as claims.10,11″

  • Anonymous

    “The profile of non-error claims we observed does not square with the notion of opportunistic trial lawyers pursuing questionable lawsuits in circumstances in which their chances of winning are reasonable and prospective returns in the event of a win are high. Rather, our findings underscore how difficult it may be for plaintiffs and their attorneys to discern what has happened before the initiation of a claim and the acquisition of knowledge that comes from the investigations, consultation with experts, and sharing of information that litigation triggers. Previous research has described tort litigation as a process in which information is cumulatively acquired.32″

    “Frivolous litigation is in the bull’s-eye of the current tort-reform efforts of state and federal legislators. The need to constrain the number and costs of frivolous lawsuits is touted as one of the primary justifications for such popular reforms as limits on attorneys’ fees, caps on damages, panels for screening claims, and expert precertification requirements. Our findings suggest that moves to curb frivolous litigation, if successful, will have a relatively limited effect on the caseload and costs of litigation. The vast majority of resources go toward resolving and paying claims that involve errors. A higher-value target for reform than discouraging claims that do not belong in the system would be streamlining the processing of claims that do belong.”

    That AP article is very biased.

  • Anonymous

    As the study points out, of that 37% (not 40) which they believed there was no medical error in, a fair percentage of those were “close calls”. Not sure how a “close call” constitutes “baseless”.

    As for your other question, if I am a client, I want to know how many jury trials the lawyer has had, the types of cases and success rate, etc. I’d also want to know, although it would be impossible to determine, how responsive the lawyer is – does he sign me up and call me in six months, or does he keep me updated on the case, etc. The reason I ask the jury trials is because insurers know who does and does not try cases and can do it well. They have that information and share it among themselves. They can probably tell you every bill you’ve ever put out that later was involved in a claim, med mal or not.

    As for hiring another lawyer, first I’d look at the fit. Second, I’d look at their people skills if they were a young lawyer. If they were an older lawyer, I’d look at their history, both financially and professionally. A great trial lawyer may be a horrible businessman. Hiring a peer in our profession is not much different than in yours I would imagine. The personality fit and ability to generate income are what matter.

  • Matthew Holt

    OK, sorry to break up this party with some data, but here goes.

    Malpractice including legal costs and payouts is way less than 1% of actual dollars. (Around $4bn total)

    Defensive medicine is in the most generous studies pegged at 8% of health spending.

    Not my numbers, the latter is not some dimwit consultant but the Republican’s friend Mark McLellan’s

    We spend more than DOUBLE most other developed nations and we don’t cover 15% of our population.

    If we took away ALL defensive medicine, we would STILL SPEND 50-70% more than basically any other country, and we would still have 15% uninsured

    Tell me again how malpractice is the biggest issue in health care?

  • Anonymous

    Mr. Holt, the ignition switch in your car probably makes up less than 1% of your car, but if it breaks I guarantee you it suddenly becomes your biggest concern.

  • Anonymous

    Mr. Holt,

    We have been around and around on this blog about the cost of defensive medicine. It would be very hard to estimate its cost. I have estimated in a routine day as an ER doc that I admit one person, do 3-4 CT’s, 5-6 x-rays, and 20 blood tests that are defensive. This is a conservative estimate. These are defensive meaning that I am 99% certain of my clinical judgement, but the malpractice environment demands 100% so objective confirmation is required. A low estimate of this cost is 15K-25K daily or around 3.5 to 6 million annually for one middle of the bell shaped curve doctor practicing in a community hospital. So 8% just doesn’t pass any type of “sniff test” to those of us who actually do this for a living every day.

  • Anonymous

    “but the malpractice environment demands 100% “

    No, as this study indicates, it does not.

    “So 8% just doesn’t pass any type of “sniff test” to those of us who actually do this for a living every day.”

    Well, what would you estimate the actual cost to be. It’s a made up number anyway, and to date Holt is right, the highest estimated is 7% of total health care costs. So since you get to make it up, what’s your dollar figure?

    Are you really advocating that we make policy based on the irrational fears of physicians?

  • Anonymous

    “but the malpractice environment demands 100% “

    No, as this study indicates, it does not.

    This study in no way disproves it. If I miss a MI in your spouse and send them home and they die, do I get to say 99 others I sent home do not.

    My guestimate in my practice environment probably approaches 50%.

    No, I do not advocate health care policy based on irrational fears.

  • Anonymous

    Mr. Holt,

    1. Are you a doctor?
    2. Have you ever been sued?

  • Anonymous

    “No, I do not advocate health care policy based on irrational fears.”

    Then don’t cite “defensive medicine” as a reason to change anything.

  • Anonymous

    Yep all those “missing” subspecialists from the ER list must be a figment of my imagination. Thanks for the clueless update CJD.

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