Archive for June, 2009

Online Doctor Ratings and Bashing

Thursday, June 25th, 2009

“Don’t see this doctor, he’s dangerous; “This guy learned all his medicine from TV on Grey’s Anatomy and ER.”  And there’s more, even the occasional compliment.

There are now hundreds of sites, mostly anonymous, that rate health care professionals, and 43 million url’s unfurled by Google with the search terms “doctor ratings.” Welcome to the world of the Internet. As Dr. Jeffrey Segal observes in Physician News Digest, “…where the paradigm argues that plumbers, roofers, contractors… are fair game,” why not docs and other health providers? Is medicine a spectator sport when results depend not only on the condition-say advanced cancer vs. a cold-or whether the patient takes his meds or keeps his appointments-but only partly on “quality of care,” whatever that is. The plumber only asks that you pay his bill for unplugging the toilet. But medical care is often delivered by a team of doctors and other professionals, and  outcomes of serious, conditions, often unknowable, are usually determined over long periods of time. In the case of a plumber,you either have hot water or cold.  If you’re a smoker, drinker, diet binger, and weigh 300 pounds, or resume weight lifting three weeks after spinal surgery, it isn’t usually the doctor’s fault if you have more problems than expected.

Why are postings bad? Because of anonymity, anyone passing as a patient, anyone with a grudge,even a competitor, can let loose with a post and more posts.  And there’s no one to stop her. Physicians are forbidden by law to respond to factually incorrect claims.  As Dr. Segal points out, the usual way to respond to offensive speech is with more speech.  Yet thanks to our friend HIPAA (the Health Insurance Portability and Accountability Act of 1996) and state privacy laws, doctors are foreclosed from this option. “A physician cannot even acknowledge that a poster is his patient.” Of course, doctors can ask patients to sign waivers but these only apply to the person signing them, not his family or friends. Others claim these waivers have a chilling effect on doctor patient relationships, and are nothing but glorified gag orders denying patients’ First Amendment rights.

Internet postings, gossip, or writings of any kind represent a growing problem for us all since they are cloaked in anonymity, the Great Protector, not only of posters but of web site accountability.For the latter, we have Section 230 of the Communication Decency Act.The best place to learn more about privacy and postings is, of course, on the Internet itself, the Great Mother of Knowledge and Opinion, invaluable and true much of the time; wrong, misleading, or dangerous the rest of the time.

The Malpractice Problem

Thursday, June 18th, 2009

When President Obama addressed the American Medical Association last week, he hoped to enlist the support of the medical profession for the Administration’s health care reform policies. Telling doctors he would work with them to limit their vulnerability to malpractice lawsuits, he drew applause. When he added that he rejected placing caps on malpractice awards, he was greeted by boos.

Many believe that putting limits on financial rewards deprives grievously harmed patients  of substantial compensation. Others note that juries are often swayed to award outrageous damages based more on the severity of  patient injuries rather than on clear evidence of negligence. Because malpractice cases often take years to come to trial, an obvious advantage over settling these cases in the courtroom would be the setting up tribunals of neutral experts, even requiring compulsory arbitration in cases of claimed negligence.

The Congressional Budget Office estimates that though putting caps on damages would ultimately reduce malpractice premiums, it would reduce health spending by only 0.5 %.  In my opinion, this figure could be a significant underestimate. It is virtually impossible to estimate the true savings by replacing our present system of litigation.Over 50% of malpractice cases are dismissed because of failure to prove physician negligence-most of these cases  are frivolous or simply misguided. Plaintiffs won only 27% of medical malpractice cases in 75 of the largest counties in the US. in 2001. Yet over 54 cents out of every dollar paid in compensation as a result of medical malpractice suits goes for legal and administrative costs. At the same time, an unknown number of victims of malpractice never sue.

I estimate up to $100 billion could be saved physicians and the health care system via the elimination of “defensive medicine” alone which drives unnecessary testing and treatment to an unimaginable degree.  To achieve these savings, drastic changes in the malpractice statutes would be required-i.e., filtering out , settling, or mediating of cases by compulsory arbitration in 95% of cases,changes requiring significant tort reform. It is indeed interesting to compare malpractice statistics in Canada with a population of 34 million (1050 cases of malpractice in 2001), with those of the U.S., population, 306 million (20,000 Payments-estimated number of cases-74,000).

Are we indeed the “land of litigation” as some people claim, or are there remedies for a flawed system of dealing with medical malpractice?