Quite a lot, explains Slate:
Doctors find retained foreign bodies in both smugglers and recreational body-packers. One experienced pleasure-seeker told an online body modification magazine that it took two years of training before he could accommodate a wine bottle””which is about three inches wide. (Now he can handle 4-inch balls.)
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Kevin, this is OT for this particular post but addresses the medical malpractice issue that you so courageously take up so often. Here’s my own suggestion for the growing masses of American physicians infuriated by the 1-2-3 sucker punch of skyrocketing BS med-mal liability, decreased reimbursements, *and* exploding medical school tuitions and loan payments: emigration from the United States, with Western Continental Europe as the prime destination.
Hear me out– I used to think this was crazy, but 5 of my former colleagues and acquaintances have done this and all 5 are very satisfied with their decisions, despite things like language barriers and cultural shocks. The medical malpractice situation in Europe is worlds apart from the US. Most places there either have a no-fault system– with patients with injuries receiving reasonable support out of a pool resembling the “vaccine compensation fund” that Atul Gawande suggested in his New Yorker article– http://www.newyorker.com/online/content/articles/051114on_onlineonly01
http://www.newyorker.com/printables/online/051114on_onlineonly01
Or, in a couple cases, they have very different mad mal systems with sharp limits on pain/suffering damages, tight leashes on malpractice lawyers, and most importantly, legal systems that have separate courts and expert panels for medicine and other specialized professions. Nothing like the catastrophic mess we currently have in the US– no multimillion dollar awards by juries who couldn’t tell an antipyretic from an anti-emetic, being suckered by malpractice lawyers and hired guns, public humiliation of hard-working physicians, awards given out for even slightly adverse outcomes that have nothing to do with the quality of care, mass naming of defendants with even only slight patient contact, and the rest of the lunacy encountered here in the United States.
The starkest differences in the med mal systems are in Sweden, Germany, France, Spain and Italy. Regrettably, England and Australia have moved in the same lunatic direction as the US on med mal and have become similarly repulsive, so if you want to do this you’ll have to learn a new language, though as my own friends and acquaintances have told me, this is not difficult when you live in the place and you have plenty of support if you’re a highly trained doctor from a US medical school.
One of my old friends is an ob-gyn originally practicing in that med mal cesspool known as New York. Another is a dermatologist– that’s right, a derm person, med mal has hit dermatology very hard, with liability and payouts for basic derm procedures and drug reactions going through the roof– from Florida. One was doing rad-onc (again, you’re not secure in any specialty anymore), one doing emergency room medicine in Oregon, and three acquaintances, two of them internists and one doing orthopedic surgery. (I’m more of a medicine than surgery person, so if my mainly medicine friends are packing up and leaving, you can only imagine what it’s like for the surgeons.)
All of them emigrated to Europe, though last I heard, the ER doc is even considering a stint in Chile. Three of them wound up in Germany, one in Austria, one in Italy, one in Spain and one in France. (None in Sweden due to language and other issues, though this should be a top choice if you can master Swedish.) I know of several other people planning on emigration to East Asian countries like South Korea, China and Taiwan (generally with familial ties there) but I really don’t know anything about medicine there, so I won’t comment.
The “ostensible” salary for a physician in Europe is obviously less than in the US, but I say “ostensible” because your true earnings are probably greater– you don’t have the med mal idiocy of the US system and other costs to eat away the misleading salary levels of the US. Furthermore, all of them are much happier there. Their practices are thriving and they practice the same good medicine they always did in the US but with, in general, more appreciative patients and a society that doesn’t treat them like dirt, or as worker horses to be parasitized at leisure by lawyers who contribute nothing to society.
I’d originally thought that the re-licensing and boarding procedures would be rivers of red tape in Europe, but they’re not nearly as bad as I thought. You do have to participate in a “quasi-residency” period to familiarize yourself with the system in Europe (and residency there is much easier than in the US), and you do have to pass some of the board exams there. But if you’re a fully trained physician from the US, there’s big demand for you there and plenty of people to help you in the process, and if you’ve been boarded in the US, the exams there are easily manageable once you have the language down. There’s also some informality to it– if you’ve made it through the pressure cooker of US training, they know you have what it takes. Only two of the seven going to Europe have family or citizenship links– the other five are native-born American citizens who are emigrating.
The language issue really isn’t that bad. Medical terminology is mainly Greco-Latin and this is about the same in the vast majority of European languages, and once you have the basics down, it just takes a couple years of practice and going through daily routines to master German, French, Spanish, Italian or Dutch. The German-speaking countries like Germany and Austria are especially good choices since they’re high-tech with a similar (often even higher) standard of living than in the United States, and despite their own issues with doctor compensation (which have led to some grumbling lately), they don’t have anything resembling the med-mal and other crises afflicting the US medical system. My ob-gyn friend is now in Stuttgart, she’s married to a German (actually a Ukrainian immigrant with German citizenship), has 3 kids, and in general finds she is practicing better medicine while simultaneously enjoying her career and outside activities more. Doctors there have both authority and respect, the ability to do quality research and patient care, and they aren’t pitted against their own patients as adversaries. This alone is a major “payment” over and above what we get in the US. They can even perform many high-risk procedures and provide great care to a larger patient population in the US, since they don’t have to worry about some moron lawyer bringing a lawsuit against them for rendering an unusually high level of care.
Just grab one of those language tapes from something like Pimsleur or Living Language or Berlitz or whatever your preference is (they’re all over the bookstore), practice conversation, and start making overseas connections. (If you’ve had to learn Spanish anyway for working in US hospitals, then you already have a path to a potential position in Spain or some of the more modernized Latin American countries like Costa Rica, Argentina or Chile.) I myself, an ER doc, as well as my cousin (who is an opthalmologist) are angling for France or Belgium within the next three years, and once we move, we’re not planning on looking back. It’s taken a while to convince my wife and sons, but they’re warming up to the idea after seeing Dad harassed day in and day out by the litigio-whore malpractice lawyers who basically dictate the course and tenor of the USA’s medical system at present.
Besides the personal benefits to physicians who make the move, this may be the one way to rescue the system back in the USA. When you have a system as thoroughly broken and corrupt as med mal in the United States, the only way to solve the crisis is to bring it to a point of maximum attention, to make it clear that Americans are suffering real pain due to the greed of malpractice attorneys. Emigration from the United States is probably the best way to deliver this much-needed shock.
BTW, I’ve come to the conclusion (after working for just a few months at an ER in Oregon), that the only way to bring about real malpractice reform in med mal crisis states like Oregon, Washington, New York, Pennsylvania and Nevada, is for those states to feel real pain from the evacuation of doctors pushed out by the malpractice idiocy there. Ob-gyns and surgeons should clear out from those 5 states en masse, so that they’re forced into the humiliation neo-17th-century state of having nobody to deliver babies for them.
If they want to parasitize their doctors and reward the malpractice lawyer thieves, then fine– they can do it at the expense of having anything remotely resembling modern medical care. This may sound cruel at first, but frankly, it’s the only damn way to effectively force states to address the med mal crisis.
Sometimes, the best way to address a crisis is to force an insidious, corrosive process to the surface with enough shock value that it affects people straight out, and they’re forced to respond. The country needs to know that it has a choice– it can pick the US-trained doctors who are among the best-trained and most driven professionals in the world, or it can choose the malpractice lawyers. The options need to be made quite stark.
Very interesting comments. I too have considered leaving the United States for a country with greater need and saner expectations. I believe that over the long run the economic compensation may be better as well. The American empire is waning as the world becomes more integrated and capital, including medical talent, becomes more mobile. Remember how all those foreign docs came to the US a generation ago seeking greener pastures? Why would anyone think the grass would remain green forever. The egress of talent in other disciplines is well underway. Follow the leaders.
I don’t know why you need to go to Europe to avoid the US malpractive cesspool….I’m going up North to Canada, though it helps that my wife is a Canadian citizen. As long as you’re willing to work in an underserved area, you’ll get a job. The pay is lower, though, unlike what alot of the Lawyer Assholes who frequent this site would say, I don’t think most of us care. i certainly don’t.
Dr. Dave
I don’t disagree with you. Infact I have looked a New Zealand (a real possibility) and Australia (from my limited understanding it is difficult for a US doc to qualify for their natinal health….I may be wrong). But I honestly think nothing will change until after the system collapses. Why? Because lawyers are infested throughout our legislative system, pure and simple.
PS: Their will be next a letter from GTL or CJD talking about how there is nothing wrong with the present system (except us). Of course since they directly and materially benefit from the present system why wouldn’t they make that argument.
I think a survey should be done of physicians asking “Would you be willing to take a 20% pay cut and in turn we would do away with the tort system?” That is what many of us are doing by leaving to practice in another country. I know I would.
How did these other socialist countries keep the legal system from going ass crazy in the medical arena? In this country the democratic party is becoming progressively more socialistic and very much in bed with the ATLA.
“How did these other socialist countries keep the legal system from going ass crazy in the medical arena?”
In some of these countries, there is socialized medicine. If you want to sue anybody, you have to sue the governement, in a government-sponsored court. So the tables are turned. Instead of the Lawyers running the scam and making the laws (like the US) The lawyers have to try and take their money from the government. It doesn’t happen.
From a socialist hell-hole:
The situation is not quite as rosy, unfortunately. Yes, the lawyers sue the government instead of the doctor (although they are now trying to do both; first sue the government and then the doctor personally). But there is a downside to the process; the cases are decided more or less behind closed doors, by lawyers (both for the government and for the plaintiff) with some tame expert witness (with predictable outcomes) as a hostage. So you might end up being officially labeled “malpractice” without having had the opportunity to open your mouth. Next time a round, the same government that paid out the financial compensation can revoke your licence without even notifying you as to why or when.
Are you guys on thorazine or haldol or what? If not. You should be! Have many times have you whined about your fear that the USA would go to a NHS?
Now you want to learn new language so you can go to the countries that have NHS.
I hope you do go. You know why? Its because you are the one’s most likely to be involved in MED MAL cases. You have zero faith in your profession, skills or patients. These countries will be saying…”We got all the misfits from the states”
On a day that many of us are writing tributes to victims of 9/11, it seems strange to see a group of physicians talking of how much they hate their own country. So much so that they want to defect. Well good riddance. Get the hell out!
And I found out last night how you get to a job as an “expert witness” I had dinner with a friend who wrote an article for the New England about Uremia. A few weeks after the article came out he started being contacted by loads of Sodomites who wanted to sue doctors for missed uremia. He’s pretty ethical; he declined of course.
“I hope you do go. You know why? Its because you are the one’s most likely to be involved in MED MAL cases.”
People who spend their Saturday Nights and Sunday Mornings are the most likely to get sued for med mal? I’d like to see the study that proves that one!
And what does Lawyers Ass-raping us to get rich have to do with 9/11? The bodies of the firefighters from 9/11 were still warm and these sodomites were already suing all the airlines involved, the US government, the city of New York, and anyone else with deep pockets. These guys are like child molestors in Thailand. They go where the Ass is and they just can’t get enough.
I truly look forward to our coming socialized medicine experiment, if for no other reason that it will expose you guys for what you truly are: greedy whiners.
The American physician is the highest paid profession in human history. They are largely respected by their patients. They are treated with deference by juries. They have been able to set up multiple hurdles which make a med mal case a very expensive process for the plaintiff to the point that only the worst injuries get compensated. They condemn anyone out of hand who dares testify against another physician, no matter how egregious the malpractice.
And still they complain. The great thing about the upcoming transition is that they will still be complaining after it’s over. It will just be a different gripe, although with the same central issue: More money.
The best thing though is that the public will quickly come to see them for what they are – just another bloated branch of government who is never satisfied with all the perks they get. You’ll be thinking “catastrophic mess”.
You clowns should listen to Samson, at least with regard to how “great” it is in other countries.
Hey Dr. Dave, did it ever occur to you if you and your cohorts in the insurance industry would offer the public something in exchange for the immunity you crave, like no-fault, you wouldn’t have to run overseas?
Hey Anon 3:40, did it ever occur to you and all the other Sodomites to offer the American public something in exchange for the lottery system that is med-mal? Say, something like “loser pays?” I guess not, cuz that might find you and all the other parasites fleeing overseas.
3:40,
The hurdle to file a med-mal suit is only a line painted on the floor. How about the wall erected to prevent filing a counter suit against the loser plaintiff attorney?
You are the one hung up on money. If a doctor wants to go to a socialist country then it certainly is not about money.
So far how many of you have left? Exactly. You boys can’t cut yourselves off from the cash, all you can do is whine.
Hey, how come none of you ever post anything about the victims of actual malpractice?
“The hurdle to file a med-mal suit is only a line painted on the floor.”
You know this because you’ve filed how many? Oh yeah, none.
They don’t post about the victims because in their warped minds there aren’t any!
Give me a job where I can go to work and accidently kill a human being and then brush it off as all being exceptable, because, hey “I can make mistakes too.”
It is not ok if your knife slips or whatever when you have a human life in your hands. It is ok if the car machanic slips up and ruines something on our cars, because, well, it is a car.
You get paid much more money than car machanics or most everyone else. It is because we expect perfection. When you are holding human lifes in your hands you better make damn sure a knife don’t slip. Your excuses are disgusting!
“Hey, how come none of you ever post anything about the victims of actual malpractice?”
“They don’t post about the victims because in their warped minds there aren’t any!”
Because that’s not what we’re seeing. We’re seeing pts. with bad outcomes sue, or examples like my lawsuit, a woman gets high on cocaine, shows up in the ER, disappears for an hour to go use more cocaine, comes back and drops dead, then the family hires a lawyer to make money because the ER Fucked up. We all have storiesd like these, not just me. The most well-respected physicans get sued for bad outcomes, and lose the lawsuit if the family is poor and gains the juries empathy. It makes us angry, and then you fucking asshole lawyers get on this site and talk about doctors being “greedy” and “maiming” patients on purpose, somehow you sodomites believe that fiction legitimizes your criminal enterprises.
The system in the US is actually pretty decent. You have patients that act and are animals. They are treated like animals. We run them through the medical system, some of them get butchered, and then we have malpractice insurance to cover our asses. Don’t complain guys, just practice defensive medicine and we’ll be alright. These animals will keep getting what they deserve…
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