July 31, 2009
New York Times
Re Dr. Arnold S. Relman’s July 31, letter: Dr. Relman mentions correctly that part of the problem with health care is the way doctors are organized.
With twenty-four different medical specialty boards, each of which protects the “turf boundaries” of its members, physicians are destined from the time they finish their residencies to isolate themselves from seeing the big picture. This fragmentation of health care by specialization, for all the good it has done to advance medical science, has at the same time neglected primary care, which like a dilapidated house, is shunned by medical students. This is one reason why so many people cannot find a primary care doctor. Fewer are being trained and many of those in practice are overworked and are not taking on new patients.
Jose Ortega y Gasset warned about the dangers of specialization over eighty years ago in his essay “The Barbarism of “Specialization’”.
If long-lasting beneficial changes are to accrue, medical educators must temper their partiality toward specialization with more attention to the practical side of medicine. If not, primary care will be provided by nurse practitioners, which although a very contentious issue for doctors, may be the single most important stroke to cutting health care’s Gordian knot.
Edward J. Volpintesta MD
Friday, July 31, 2009
A specious argument, frequently used by opponents of health reform
July 30, 2009
New York Times
Re “New Poll Finds Growing Unease On Health Plan” (page 1, July 31): Opponents of a government-sponsored health plan say that it will prevent patients from seeing the doctor of their choice. The implication is that private insurance allows patients to see any doctor they choose.
Both are misleading. Patients’ ability to see any physician they want will depend on whether the physician is taking new patients or whether the physician accepts the insurance plan--public or private. Thus it is only partly true that anyone, regardless of their insurance, public or private, has complete freedom to choose any doctor they want.
Lawmakers need to bring this to the public’s attention.
Edward J. Volpintesta MD
New York Times
Re “New Poll Finds Growing Unease On Health Plan” (page 1, July 31): Opponents of a government-sponsored health plan say that it will prevent patients from seeing the doctor of their choice. The implication is that private insurance allows patients to see any doctor they choose.
Both are misleading. Patients’ ability to see any physician they want will depend on whether the physician is taking new patients or whether the physician accepts the insurance plan--public or private. Thus it is only partly true that anyone, regardless of their insurance, public or private, has complete freedom to choose any doctor they want.
Lawmakers need to bring this to the public’s attention.
Edward J. Volpintesta MD
Wednesday, July 29, 2009
Lawmakers must address tort reform
July 29, 2009
The Day
Your July 29, editorial “Include Tort Reform” hit the nail on the head. The malpractice system has many flaws, the worst being that it forces doctors to practice defensively. This wastes incalculable amounts of money on unnecessary tests just to ward off malpractice suits.
No doctor wants to risk malpractice because just one suit, even a frivolous one, has the potential to ruin his or her career. Besides wasting money, defensive medicine subjects patients to unnecessary biopsies, treatments, and medications that carry the risk of complications and even death.
Clearly, the fear of malpractice suits is one of the factors that contribute to the high cost of care everywhere in this country. 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.
Putting caps on excessive awards while compensating injured patients fairly and reasonably is one solution. Another is to use a workers’ compensation type method.
Lawmakers must address the reasons why doctors practice defensively and find the compromise that treats all parties fairly and reasonably.
Edward J. Volpintesta MD
The Day
Your July 29, editorial “Include Tort Reform” hit the nail on the head. The malpractice system has many flaws, the worst being that it forces doctors to practice defensively. This wastes incalculable amounts of money on unnecessary tests just to ward off malpractice suits.
No doctor wants to risk malpractice because just one suit, even a frivolous one, has the potential to ruin his or her career. Besides wasting money, defensive medicine subjects patients to unnecessary biopsies, treatments, and medications that carry the risk of complications and even death.
Clearly, the fear of malpractice suits is one of the factors that contribute to the high cost of care everywhere in this country. 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.
Putting caps on excessive awards while compensating injured patients fairly and reasonably is one solution. Another is to use a workers’ compensation type method.
Lawmakers must address the reasons why doctors practice defensively and find the compromise that treats all parties fairly and reasonably.
Edward J. Volpintesta MD
Defensive medicine must be put on health care agenda
July 29, 2009
Stamford Advocate
Reform of the malpractice system was not mentioned in your July 29, editorial “Health Care: Obama’s Waterloo”?
Yet, the malpractice system raises the costs of health care immensely. This is because doctors frequently order tests and consultations to defend themselves in case a malpractice suit is filed. This is called defensive medicine. Doctors practice defensively because just one unwarranted suit has the potential to ruin their reputations and careers.
Some people confuse defensive medicine with thoroughness and competence, thinking that the more tests the better. But, defensive medicine actually complicates their care and can expose them to risky procedures and treatments.
Putting fair limits on malpractice payouts is one antidote to defensive medicine that is often mentioned. Another is using a workers’ comp method. Both methods treat injured patients fairly and eliminate the time-and-money-consuming wrangling that occurs otherwise. The result is that patients get their compensation more quickly.
Needless to say, these methods would lessen the pressure for doctors to practice defensively. Our lawmakers must put defensive medicine on the table. Ignoring it is like ignoring the red warning light on a car’s dash board indicating that you have engine trouble.
Edward J. Volpintesta MD,
Stamford Advocate
Reform of the malpractice system was not mentioned in your July 29, editorial “Health Care: Obama’s Waterloo”?
Yet, the malpractice system raises the costs of health care immensely. This is because doctors frequently order tests and consultations to defend themselves in case a malpractice suit is filed. This is called defensive medicine. Doctors practice defensively because just one unwarranted suit has the potential to ruin their reputations and careers.
Some people confuse defensive medicine with thoroughness and competence, thinking that the more tests the better. But, defensive medicine actually complicates their care and can expose them to risky procedures and treatments.
Putting fair limits on malpractice payouts is one antidote to defensive medicine that is often mentioned. Another is using a workers’ comp method. Both methods treat injured patients fairly and eliminate the time-and-money-consuming wrangling that occurs otherwise. The result is that patients get their compensation more quickly.
Needless to say, these methods would lessen the pressure for doctors to practice defensively. Our lawmakers must put defensive medicine on the table. Ignoring it is like ignoring the red warning light on a car’s dash board indicating that you have engine trouble.
Edward J. Volpintesta MD,
Public neglecting defensive medicine
July 29, 2009
Connecticut Post
It is disappointing that there has been no discussion on defensive medicine in your letters section. Most patients know that doctors frequently order more tests than necessary in order to have a defense in case a malpractice suit is filed. This raises the cost of health care immeasurably. Ironically, some people actually favor defensive medicine. They think that ordering every possible test is good because it eliminates mistakes.
Clearly, they do not know that unneeded tests can subject them to risky biopsies and medical procedures, leading to serious complications, even death.
Putting limits on malpractice suits is one way of controlling defensive medicine. Another is to use a workers’ compensation type method. Both methods will make restitution to patients for fair and reasonable amounts. At the same time they will eliminate excessive awards and cut down on legal fees. By avoiding the long drawn-out wrangling that usually occurs, injured patients receive payments quicker.
Doctors will feel less pressured to practice defensively because both methods reduce their chances of having their reputations and careers destroyed by just one suit.
Health reform is complicated. There is no single solution. Correcting the reasons why doctors practice defensively will contribute substantial savings to the system.
Lawmakers need to address this issue.
Edward J. Volpintesta, MD
Connecticut Post
It is disappointing that there has been no discussion on defensive medicine in your letters section. Most patients know that doctors frequently order more tests than necessary in order to have a defense in case a malpractice suit is filed. This raises the cost of health care immeasurably. Ironically, some people actually favor defensive medicine. They think that ordering every possible test is good because it eliminates mistakes.
Clearly, they do not know that unneeded tests can subject them to risky biopsies and medical procedures, leading to serious complications, even death.
Putting limits on malpractice suits is one way of controlling defensive medicine. Another is to use a workers’ compensation type method. Both methods will make restitution to patients for fair and reasonable amounts. At the same time they will eliminate excessive awards and cut down on legal fees. By avoiding the long drawn-out wrangling that usually occurs, injured patients receive payments quicker.
Doctors will feel less pressured to practice defensively because both methods reduce their chances of having their reputations and careers destroyed by just one suit.
Health reform is complicated. There is no single solution. Correcting the reasons why doctors practice defensively will contribute substantial savings to the system.
Lawmakers need to address this issue.
Edward J. Volpintesta, MD
Tuesday, July 28, 2009
Alpha and Omega of Medicine
July 28, 2009
Wall Street Journal
Regarding Melinda Beck’s article, “Injecting Value Into Medical Decisions” (personal journal, July 28):
Quality of care is a vague term when applied to the health system and offers little to defining its problems. Robert Pirsig in his book Zen and the Art of Motorcycle Maintenance: An Inquiry into Values devoted a large portion of his book to searching for a meaning. He said it is hard to define quality but everyone recognizes it when they see it. He never arrived at a clear definition but he did mention that the Greek word arête which means wholeness or oneness of life came close.
We can recognize quality in a car or a computer because it is an inanimate object with quantifiable attributes, like simplicity, efficiency, and durability, for example.
But health care is not a manufactured product and illness is not an isolated quantifiable portion of a person’s total make-up. Each patient is a seamless composite of mind, soul, and body, each of which are inextricably linked.
Quality as many define it focuses on the body portion mainly. This fragmentation of a sick person focuses on cost-reduction and transforms physicians from their roles as healers into business-minded scientists. Quality is often used by health insurers to create guidelines that ostensibly are meant to control costs while improving health standards. But very often they are used to control doctors’ spending patterns in order to increase corporate profits. This approach ignores the wholeness and oneness of life.
True, doctors order unnecessary tests (defensive medicine), lowering the simplicity and economy that quality implies. But this is done to protect themselves against frivolous malpractice suits. Opponents of tort reform that aim at eliminating defensive medicine make the serious mistake of saying that it raises the quality of medicine because the more tests and consultations the better, even when unneeded because patients are given the maximum benefits of modern medicine. Crazy logic like this has been in play for over twenty years and is one reason why health care is so expensive.
In the dictionary of medicine there is no quality care. Only good care and bad care, humane care and inhumane care.
The wholeness and the oneness of life are the alpha and omega of medicine.
Edward J. Volpintesta MD
Wall Street Journal
Regarding Melinda Beck’s article, “Injecting Value Into Medical Decisions” (personal journal, July 28):
Quality of care is a vague term when applied to the health system and offers little to defining its problems. Robert Pirsig in his book Zen and the Art of Motorcycle Maintenance: An Inquiry into Values devoted a large portion of his book to searching for a meaning. He said it is hard to define quality but everyone recognizes it when they see it. He never arrived at a clear definition but he did mention that the Greek word arête which means wholeness or oneness of life came close.
We can recognize quality in a car or a computer because it is an inanimate object with quantifiable attributes, like simplicity, efficiency, and durability, for example.
But health care is not a manufactured product and illness is not an isolated quantifiable portion of a person’s total make-up. Each patient is a seamless composite of mind, soul, and body, each of which are inextricably linked.
Quality as many define it focuses on the body portion mainly. This fragmentation of a sick person focuses on cost-reduction and transforms physicians from their roles as healers into business-minded scientists. Quality is often used by health insurers to create guidelines that ostensibly are meant to control costs while improving health standards. But very often they are used to control doctors’ spending patterns in order to increase corporate profits. This approach ignores the wholeness and oneness of life.
True, doctors order unnecessary tests (defensive medicine), lowering the simplicity and economy that quality implies. But this is done to protect themselves against frivolous malpractice suits. Opponents of tort reform that aim at eliminating defensive medicine make the serious mistake of saying that it raises the quality of medicine because the more tests and consultations the better, even when unneeded because patients are given the maximum benefits of modern medicine. Crazy logic like this has been in play for over twenty years and is one reason why health care is so expensive.
In the dictionary of medicine there is no quality care. Only good care and bad care, humane care and inhumane care.
The wholeness and the oneness of life are the alpha and omega of medicine.
Edward J. Volpintesta MD
Rivalry and Mistrust Among Physicians
July 28, 2009
AMedNews
AMA president Dr. J. James Rohack in his article “Reform needs a more rational insurance purchasing system” (AMedNews, July 27) repeated Sir William Osler’s warning that physicians’ “rivalry and mistrust” towards one another was shameful. This is timely and important advice.
Unfortunately, our specialty societies are the main contributors to this internecine tension. Rivalry and mistrust has steadily worsened since Sir William Osler first reflected on them in 1875. They not only undermine solidarity among doctors but have also limited their abilities to provide a physician workforce in touch with the needs of society. This is most apparent in the area of primary care.
Allowing itself to become infatuated with specialism, the profession has failed to nurture general practice. Overshadowed and pushed aside by specialty medicine for decades, primary care is almost at the tipping point of no return.
Whether or not primary care will be saved will be the greatest test of whether Sir William Osler’s words have been heeded or not.
Edward J. Volpintesta MD
AMedNews
AMA president Dr. J. James Rohack in his article “Reform needs a more rational insurance purchasing system” (AMedNews, July 27) repeated Sir William Osler’s warning that physicians’ “rivalry and mistrust” towards one another was shameful. This is timely and important advice.
Unfortunately, our specialty societies are the main contributors to this internecine tension. Rivalry and mistrust has steadily worsened since Sir William Osler first reflected on them in 1875. They not only undermine solidarity among doctors but have also limited their abilities to provide a physician workforce in touch with the needs of society. This is most apparent in the area of primary care.
Allowing itself to become infatuated with specialism, the profession has failed to nurture general practice. Overshadowed and pushed aside by specialty medicine for decades, primary care is almost at the tipping point of no return.
Whether or not primary care will be saved will be the greatest test of whether Sir William Osler’s words have been heeded or not.
Edward J. Volpintesta MD
Sunday, July 26, 2009
Defensive Medicine: Medical Reform's Achilles' Heel
Only Reforms Can End Defensive Medicine (published in Hartford Courant, July 17)
Defensive medicine, the unnecessary tests and consultations that doctors order to protect against malpractice suits, is a black hole that consumes incalculable amounts of money and wastes medical resources and doctors' time. But the worst thing about defensive medicine is that it sometimes exposes patients to risky biopsies, medical procedures and useless attempts to save lives for which there is no hope of survival.
Many doctors believe that placing fair and reasonable limits on the amounts of the awards given patients in successful malpractice suits is a good way to reduce the practice of defensive medicine and, of course, to help reduce the cost of health care.
Theoretically and practically, this makes sense. But some opponents of this approach say that defensive medicine is a myth and that the real motive is greed. They say doctors order unnecessary tests not from fear of malpractice suits but for the money they make doing them.
To be sure, there are some physicians, very few, who may order unneeded tests because they own expensive equipment to perform CAT scans or MRIs and feel pressured to use them indiscriminately. But the great majority of physicians do not fall into this category. Most doctors, like accountants, lawyers, carpenters, plumbers and most other workers in all walks of life, practice ethically and do not take advantage of the public.
Defensive medicine was mentioned in a recent article written by Dr. Atul Gawande in the New Yorker magazine, which has received widespread attention. The author implied that because Texas' malpractice laws have a $250,000 cap on pain and suffering, doctors there are not under acute pressure to practice defensive medicine. 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 percent reduction in malpractice suits, according to an article published in the Sept. 8, 2008, issue of American Medical News, the official newspaper of the American Medical Association. Clearly, there is a world of difference between malpractice suits going down to "practically zero" vs. being reduced by 50 percent.
Even if the number of malpractice cases filed were nearing zero, doctors would still practice defensively because undergoing one is a devastating ordeal for them. No doctor wants to risk malpractice because just one suit, even a completely unjustified one, has the potential to ruin a career.
Ironically, the majority of malpractice suits that go to trial are ruled in favor of doctors. The fear of malpractice suits is one of the factors that contributes to the high cost of care in Texas as much as it does in any other state, including Connecticut.
Clearly, a more balanced method of handling malpractice cases is needed: one that treats patients fairly and does not destroy doctors' careers or reputations. Without significant reforms in the rules for malpractice suits and awards, doctors will continue to practice defensively. And defensive medicine will remain the wild card that drives the cost of health care higher every year.
Besides placing limits on the amounts awarded in malpractice suits, there are other reforms that have been proposed. One is based on the workers' compensation system. It would give injured patients fair compensation. This would avoid the necessity of a court battle and the agony that patients and doctors are forced to undergo.
This problem will never be solved to everyone's satisfaction, but compromise and fairness to all is possible. The success of Connecticut's plans to cover everyone with health insurance will depend in great part on how well lawmakers address the causes of defensive medicine.
Too much is at stake to ignore it.
Ed Volpintesta MD
Defensive medicine, the unnecessary tests and consultations that doctors order to protect against malpractice suits, is a black hole that consumes incalculable amounts of money and wastes medical resources and doctors' time. But the worst thing about defensive medicine is that it sometimes exposes patients to risky biopsies, medical procedures and useless attempts to save lives for which there is no hope of survival.
Many doctors believe that placing fair and reasonable limits on the amounts of the awards given patients in successful malpractice suits is a good way to reduce the practice of defensive medicine and, of course, to help reduce the cost of health care.
Theoretically and practically, this makes sense. But some opponents of this approach say that defensive medicine is a myth and that the real motive is greed. They say doctors order unnecessary tests not from fear of malpractice suits but for the money they make doing them.
To be sure, there are some physicians, very few, who may order unneeded tests because they own expensive equipment to perform CAT scans or MRIs and feel pressured to use them indiscriminately. But the great majority of physicians do not fall into this category. Most doctors, like accountants, lawyers, carpenters, plumbers and most other workers in all walks of life, practice ethically and do not take advantage of the public.
Defensive medicine was mentioned in a recent article written by Dr. Atul Gawande in the New Yorker magazine, which has received widespread attention. The author implied that because Texas' malpractice laws have a $250,000 cap on pain and suffering, doctors there are not under acute pressure to practice defensive medicine. 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 percent reduction in malpractice suits, according to an article published in the Sept. 8, 2008, issue of American Medical News, the official newspaper of the American Medical Association. Clearly, there is a world of difference between malpractice suits going down to "practically zero" vs. being reduced by 50 percent.
Even if the number of malpractice cases filed were nearing zero, doctors would still practice defensively because undergoing one is a devastating ordeal for them. No doctor wants to risk malpractice because just one suit, even a completely unjustified one, has the potential to ruin a career.
Ironically, the majority of malpractice suits that go to trial are ruled in favor of doctors. The fear of malpractice suits is one of the factors that contributes to the high cost of care in Texas as much as it does in any other state, including Connecticut.
Clearly, a more balanced method of handling malpractice cases is needed: one that treats patients fairly and does not destroy doctors' careers or reputations. Without significant reforms in the rules for malpractice suits and awards, doctors will continue to practice defensively. And defensive medicine will remain the wild card that drives the cost of health care higher every year.
Besides placing limits on the amounts awarded in malpractice suits, there are other reforms that have been proposed. One is based on the workers' compensation system. It would give injured patients fair compensation. This would avoid the necessity of a court battle and the agony that patients and doctors are forced to undergo.
This problem will never be solved to everyone's satisfaction, but compromise and fairness to all is possible. The success of Connecticut's plans to cover everyone with health insurance will depend in great part on how well lawmakers address the causes of defensive medicine.
Too much is at stake to ignore it.
Ed Volpintesta MD
Health reform incomplete without addressing reform of malpractice system
July 25, 2009
New York Times
To the Editor:
Re “Health Reform and You” (Editorial, July 25): The need for reforming the malpractice system so that doctors are not forced to practice defensive medicine was not mentioned. Yet, defensive medicine is responsible for wasting immeasurable amounts of money, medical resources, and doctors’ time. Not to mention, exposing patients to unneeded medical procedures, biopsies, and medications.
The so-called “comparative effectiveness” studies meant to help doctors choose the most cost-effective and safest way to treat patients might be helpful, theoretically. But, because of the terrible threat to their reputations and careers posed by even one frivolous malpractice suit, most doctors will continue to practice defensive medicine.
Until doctors are treated fairly and reasonably by the malpractice system, cost control and patient safety will not have been adequately addressed.
Edward J. Volpintesta MD
New York Times
To the Editor:
Re “Health Reform and You” (Editorial, July 25): The need for reforming the malpractice system so that doctors are not forced to practice defensive medicine was not mentioned. Yet, defensive medicine is responsible for wasting immeasurable amounts of money, medical resources, and doctors’ time. Not to mention, exposing patients to unneeded medical procedures, biopsies, and medications.
The so-called “comparative effectiveness” studies meant to help doctors choose the most cost-effective and safest way to treat patients might be helpful, theoretically. But, because of the terrible threat to their reputations and careers posed by even one frivolous malpractice suit, most doctors will continue to practice defensive medicine.
Until doctors are treated fairly and reasonably by the malpractice system, cost control and patient safety will not have been adequately addressed.
Edward J. Volpintesta MD
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