The triumph of language over truth

August 25, 2009
New York Times


How does something as humane and reasonable as “end-of-life discussions” get turned into something as repulsive and hideous as “death panels”?

The whole thing may have started with something as benign sounding as the “medical home”, a concept some medical organizations have been pushing for. The idea is to pay primary care physicians for the coordinating functions which ordinarily they are not. It’s a way of making primary care more attractive for medical students most of whom are shunning it because of too much work and too little pay.

The coordinating activities include end-of-life discussions with patients in which doctors try to get a sense how intensively they want to be treated if their condition becomes irreversibly bad.

I suspect that when those opposed to health reform got wind of doctors being paid for “advance directives”, they manipulated the language to their advantage. By calling advance directives “death panels” they flipped president Obama’s “public option” on its back like a helpless turtle.

This might have been prevented if physicians were given a larger role in the health care debate. So far, the democratic process has circumvented them. They must be more visible and more vocal. Their input is vital and yet they are invisible. Perhaps that, more than anything else is the hallmark of the discussions so far.

Edward Volpintesta MD

Media reports on medical mistakes misleading

August 24, 2009
Connecticut Post

In your August 24 editorial “Patients have a right to know about mistakes” you were correct to say that “patients have a right to know about mistakes”. But patients also have a right to know that some of the reports on mistakes have been based on methods that are questionable and have over estimated the numbers.

For example the Institute of Medicine in 1999 estimated the number of preventable deaths to be between 44,000 and 98,000 yearly. Unfortunately, only the high number of that estimate is ever mentioned by the media. And I suspect that it is that high number that is included in your editorial.

This exaggerates the number of errors and unnecessarily frightens the public. Worse, it undermines their confidence in the medical profession.

Interestingly, in the August 20, 2001 issue of American Medical News reported that a follow-up study on medical errors placed the number of preventable deaths as between 5,000 and 15,000. But that report is never mentioned by the media.

Even one mistake is a tragedy. And the public certainly has a right to know about them. But it should also know that doctors and hospitals work hard reviewing such incidents and making every effort to make sure they don’t recur.

Edward J. Volpintesta MD

Malpractice reform ignores what bothers doctors most

August 24, 2009
Washington Times


To the Editor,

Re the August 23 “Solutions: malpractice litigation in U.S. health care reform”. It is disappointing that the authors did not consider the psychological factors driving physicians to change the malpractice laws.

More than the increasing costs of malpractice insurance, physicians constantly worry about the effects that even one frivolous malpractice suit can have on their reputations, their careers, and their livelihoods. Even though most of the malpractice suits that end up in court are decided in favor of the doctor, they wait on tenterhooks for four or more years before the case is settled. The stress involved can be overwhelming.

Who wants to be operated on by a surgeon who is distracted by the specter of a lawsuit hanging over his head while he has a scalpel in his hand ready to operate at 3 a.m. under emergency conditions?

Most doctors who have undergone a suit, even one from which they were exonerated admit that the experience was life-altering. Many of them come to view patients as potential lawsuits waiting to happen. For that reason they practice defensive medicine, that is, they order unnecessary tests and consultations in order to have a good defense in case a suit is filed. Not only does this raise the cost of care immeasurably, it also subjects patients to risky procedures.

Malpractice reform should consider the methods used in Scandinavia. There, a form of workers’ compensation insurance is used. Good doctors do not worry about having their reputations and careers destroyed and patients are compensated fairly and reasonably.

Edward J. Volpintesta MD

Where are doctors in the health care debates?

August 23, 2009
Hartford Courant

U.S. Rep (D) Chris Murphy, in his August 23 article “Health Reform Far Too Important For Shouting” laments the shouting and disruption that have come to be the hallmark of the town hall meetings on health care reform.

Perhaps the problem is that the debates on health care have been defined and led almost exclusively by politicians with very little direct participation from physicians. Marginalizing doctors is counterproductive to the whole democratic process. Leaving them out of it is a big reason why the debates have been ineffective.

If Congressman Murphy wants to put these debates in a more positive and constructive light he would do well to give physicians a stronger presence at them. After all, it is physicians who take care of patients. Who is better-positioned than they to clarify the questions that attendees at the town hall meetings have. And who knows more about end-of-life issues and the problems with health insurers than doctors? They deal with these issues day in, day out.

Clearly, health reform is far too important to leave doctors out of the debates.

Edward J. Volpintesta MD

How credible is the Institute of Medicine's report on medical errors published in 2000?

August 22, 2009
American Medical News

Regarding “When the Institute of Medicine reports, the country listens” (AMNews, August 17): The Institute of Medicine (IOM) has produced some reports of some value including the often quoted “To Err is Human: building a safer health care system”. Most of what the IOM reports is already known. But published under the aegis of the IOM, its reports take on a sovereign aspect that can have unintended effects of questionable value.

Nowhere is this more apparent than in the above mentioned study on medical errors. That study published in 2000 was based on information from hospitals in three states and in different years. It included Colorado (1992), Utah (1992), and New York (1984). The conclusions were that between 44,000 and 98,000 deaths occurred in the US each year because of medical errors. U.S.

A follow-up study published in the Journal of the American Medical Association in 2001 disputed the IOM’s methods and results, lowering the estimate of deaths to between 5,000 and 15,000. That study, however, has never received any publicity. Neither has the IOM ever made any comment on it.

Needless to say, even one preventable death is a tragedy which is why hospitals have peer review committees and work hard to improve safety.

The president of the IOM was quoted as saying that his “only real job was to tell the truth”. Telling the truth is an awesome responsibility. When there are conflicting opinions held on both sides of a question by reputable sources, as occurred in the study on medical errors, the truth most likely lies somewhere in the middle and deserves clarification.

Otherwise, as happened with the IOM report on medical errors, information that is questionable may be used to undermine confidence in the medical profession by those who have political agendas that are antagonistic to physicians.

The follow-up report on medical errors published in JAMA makes me wonder whether the IOM is as objective as it likes to believe that it is.

Edward J. Volpintesta MD

Physicians not included in health debate

August 21, 2009
Danbury News Times

Misrepresentation and mayhem have become the hallmarks of the debate on health care. Specifically, the use of the term “death squad” as a substitute for “advance directives” is the worst example to yet appear. Advance directives are well-considered plans that patients make to provide doctors with guidelines on how aggressively they want to be treated should they become severely ill and their prognosis is dire. Every attempt is made to be sure that the plans are medically and legally correct. No patient ever gets the plug pulled just to save the health system money.

Those who bring “death squads” into the health debate are guilty of either political posturing or misinformed. Either way, the result is the same. Patients become frightened unnecessarily and discussion degenerates into chaos.

The fear conveyed by such distorted and untruthful information contained in terms like “death squads” could have been prevented if physicians were accorded their proper role in the health debate. The debates on TV rarely have physicians presenting their sides of the problem. Most of the health talk is by journalists who have little experience or knowledge of actually taking care of patients.

How can a journalist or a politician who has never had to take care of a patient with a ruptured appendix or a patient with life-threatening injuries suffered in a high-speed automobile accident even come close to knowing what is right or wrong with the health care system? Or never having had to fight with an insurer over the need for a CAT scan or having been faced with an unwarranted malpractice suit?

Until physicians are invited to play a bigger role in the health care discussions, misinformation and political posturing will continue to pollute the information that the public is supplied with.


Edward J Volpintesta MD

More than money is needed to restore prestige to primary care

August 19, 2009

USA Today
Letters Editor

It will take more than money to restore primary care’s prestige (Doctor shortage: Primary care losing its prestige” front page, Wednesday). Most primary care physicians have become primary care case coordinators. It has become almost impossible for them to keep up with the rapid advances of medicine and they depend heavily on specialists. That and the regulations of health insurers have made primary care doctors function as “health care brokers”. Their days are often spent poring over lab reports and fighting with insurers over which drug is allowed for a patient. They spend less time than ever with patients. Clearly a new paradigm is needed for primary care.

For their new roles a “hybrid” primary care doctor is needed. This means shortening their training period by two to three years so that it reflects what they actually do in the real world and not what medical educators think they should be doing. Clearly medical schools have been out of touch with what primary care doctors do.

Turning out primary care doctors for the new role that they have evolved into will cut down on their education debts and will lead to the hybrid doctor that is needed. Job satisfaction and prestige depend on a clearly defined and manageable role. Both are missing in primary care and the answer is not to pay them more.

Edward J. Volpintesta MD

Advising patients not to have tests can be a source of malpractice suits

Wall Street Journal
August 8, 2009

Regarding “Imagine Doctors, Patients Talking” by Kristen Gerencher in the August 6 issue: Ideally, having doctors and patients discussing whether a certain test or procedure is necessary makes good sense. Immeasurable amounts of time and money are wasted on unnecessary tests; and they can subject patients to risks.

But what happens when it is determined several months later that the test which the doctor talked the patient out of having would have prevented a cardiac condition or diagnosed a cancer?

The point is that until the malpractice laws are changed so that doctors are not penalized for using their judgment, most doctors will be very tentative about talking patients out of tests. This is the modus operandi that prevails.

Health reform without tort reform is incomplete.

Edward J. Volpintesta MD

What's missing in the health care debate?

August 7, 2009
The Providence Journal

To the Editor,

Re “Medical tort reform could save billions” by Philip K. Howard in the August 6 issue: Attorney Philip K. Howard hit the nail on the head. It is common knowledge that the overwhelming majority of physicians order unnecessary tests in order to have good defense in case a suit is filed. They know that even one unwarranted malpractice suit can destroy their reputations and ruin their careers.

No physician in his right mind is willing to take that chance, regardless of how good his relationship is with a patient. Frequently it a litigious relative by injecting negative comments about the patient’s care, instigates a malpractice suit that would otherwise never have been filed. Sometimes it is the patient’s estate. But the point is that even if a doctor is exonerated by a jury, as often happens, he will still have been forced to undergo one of the most trying and difficult experiences of his life. Any doctor who has had the bad fortune to have the experience will tell you that his or her attitude towards patients and the health system change forever.

After a lawsuit, a physician cannot help practicing defensively. Nor can he help viewing patients as potential law suits. This unhealthy state of affairs has been going on for at least thirty years. It’s time that our lawmakers muster the courage and faced this problem head-on.

Edward J. Volpintesta MD