Dr. Atul Gawande wrote an interesting article in the New Yorker. By studying a Texas town with unusually high health care costs, he concluded that the incentives for doctors to be paid separately for each patient and procedure and in some cases fueled by an entrepreneurial spirit were responsible for the unusally high cost of health care there; and how this approach may be responsible for high costs of health care everywhere.
The article was good particularly his suggestions how doctors in their local communities could control health costs but his conclusion that the fear of malpractice threats and defensive medicine did not raise the cost of health care are questionable.
Here is my response to The New Yorker.
June 7, 2009
The New Yorker Magazine
I have difficulty accepting Atul Gawande’s conclusions about defensive medicine (the ordering of more tests than necessary in order to have a good defense in case a malpractice suit is filed) in his June 1 article “The Cost Conundrum”.
He suggests that because Texas’s malpractice laws have a $250,000 cap on pain and suffering, doctors they are not under acute pressure to practice defensive medicine, that is, order more tests than necessary in order to have good defense in case a suit is filed.
He based this on a cardiologist he interviewed who mentioned that malpractice cases had gone down “practically to zero”.
But Texas Liability Trust, the largest liability carrier in Texas reported only a 50% reduction in malpractice suits according to an article published in the September 8 issue of American Medical News, the official newspaper of the American Medical Association.
Even if the number of malpractice cases filed were “practically to zero”, doctors would still practice defensively because undergoing one is a terrible ordeal. No doctor wants to risk malpractice because just one suit, even a frivolous one, has the potential to ruin his or her career.
The fear of malpractice suits is one of the factors that contribute to the high cost of care in Texas as much as it does anywhere and until a more humane method of treating malpractice cases is established—one that does not destroy doctors’ reputations, or cause them unnecessary distress as they wait on tenterhooks waiting for the outcome of a case—doctors will continue to practice defensively.
The solution to the cost conundrum includes reforming the malpractice laws.
Edward J. Volpintesta MD
Quality care brings physicians higher pay
9 hours ago
2 comments:
I agree completely with you. I kept reading Dr. Gawande's article waiting for him to comment on the role of malpractice, which he did not do. In Cook County, IL, malpractice affects 1 in 5 doctors per year. There is no question that the fear of malpractice drives doctors to order tests in order to protect themselves. Places like the Mayo Clinic can afford to miss a diagnosis occasionally because of what I call, the "protection of their reputation". Community doctors don't receive the same understanding from a jury if they fail to order a test in the spirit of cost containment. Malpractice reform has been given very little attention in the healthcare debates and the lawyers are collectively hoping that it stays that way.
I have two reasons for being skeptical of your response. For one thing, McAllen and the surrounding area (Hidalgo county has a population of 700,000 by the way, so we aren't just talking about a "small town") is very poor. The Texas law limits punitive and pain and suffering damages but not compensitory damages from future health care costs or lost income. Malpractice attorneys are much less willing to represent poor people who are harmed, as unless they run up high medical bills they won't be getting much money no matter how strong the case or egregious the error. Hence, it is entirely possible that lawsuits in Hidalgo county have fallen substantially more than in the rest of Texas. If someone has actual data here, I'd like to see it.
Second, if reducing the number of malpractice suits "practically to zero" wouldn't reduce defensive medicine, well, I don't know what to say exactly. Seeing as how we aren't going to ban all malpractice suits, it sounds like we will have to find other sources of savings.
For the record, I support the Texas law, but I wish people wouldn't expect miracles out of malpractice reform.
Post a Comment
Please post your comments here. All comments are moderated before publication, so there may be a delay before you see your comment appear on the site. You may also email your private comments to info@yjhm.org if you do not want them to appear publicly. Thanks for your feedback. -- YJHM Editors
NOTE: If you receive an error message when submitting a comment, please click the "Preview" button and proceed as instructed.