Wait, wait, wait. You are confusing me. I said that in order to be impartial, you couldn't have doctors on the jury. The wording was a bit ambiguous.

Well, I'm not talking about the juries. I'm talking about the doctor. Has a doctor confessed to ever doing wrong? I'm not picking on doctors. I just think they are like everybody else (in general) and think of the bottom line. My fellow pre-med students at UC Irvine would have stabbed me in the back just to move up one place on a test. Maybe it's just Alzheimer's.

Once again, this isn't a blanket indictment. Just an anecdote. No fingers are being pointed, except at the human race, so I'm pointing at me right now. I agree that idiots have to take responsibility for their own mistakes, no matter if they're piss-poor and ignorant or on the opposite end of the spectrum.

In other words, it's not black and white, but only shades of grey.

quote:

Has a doctor confessed to ever doing wrong?

I don't know...I couldn't give you any instances, but usually people defend themselves even if they did it because there's nothing to lose by defending yourself (other than massive quantities of time and money), and because if you submit, you have to pay massive amounts of money, and on top of that, your life is ruined. Not really a win-win there, is it?

quote:

Originally posted by mark f:
Has a doctor confessed to ever doing wrong?

I've stayed out of this whole debate because it's a bit touchy for me. Hell, for me this is like the religion thread for some.

Yes, doctors confess to wrongdoing all the time. In fact, there is a culture in medicine of airing your mistakes and complications in a closed, professional, peer review atmosphere. It's called many different things, although most of the time they are called Morbidity and Mortality conferences. They are held in the spirit of learning from your mistakes and the mistakes of others. The goal is to improve patient care. The information is not discoverable.

Legally, doctors admit wrongdoing as well. It's called "settling a case." If the doctor feels that what s/he did was not defensible, then they will settle, rather than be dragged through the mud in a trial. However, some settlements are not about admission of wrongdoing, but about a calculation of the cost/benefit ratio of allowing a case to go to trial. Cost of attorney's fees, and time lost from your work to defend, and the psychological cost of putting yourself out there for a panel of people to pass judgement on you. People who don't know you, what you've done, what you've sacrificed, how long you've trained, and who simply view you as a deep pocket.

Most physicians win lawsuits. Most frivolous lawsuits never make it past the threat or served stage. However, the costs to the physician are enormous, and not just financially.

Never thought I'd quote the National Review, but I think they got it just about correct in this piece. John Edwards and "junk science"

I'm a liberal democrat in almost every way, but tort reform is a sacred cow for me. I'd probably vote for a Bush again before I voted for Edwards.

Gaah. Sorry, I just vomited up a little bit of liquid into my mouth.

This message has been edited. Last edited by: kendocubano,

I'm with sinister in all of this. My dad is a doctor and I know first hand about some of the shit he's had to go through. I'm not allowed to tell the story I'm thinking of(since the case is still going on) but the malpractice lawyers shoot a shotgun at the hospital. They look at a list of the people attached to the case and they sue, even if its the anesthesiologist (no my dad is not an anesthesiologist) who didn't do anything wrong. Malpractice insurance for a practice can be $100,000 a year. I remember this one case I read about where a obese 19 year old kid has back pain. So he goes to the good ole doc and the guy decides to do surgery. The doc botches and the guy rightfully sues, since he is now paralyzed from the waist down. Problem is, the guy also sues the neurosurgeon and the anesthesiologist. The neurosurgeon was in surgery for ten minutes to ensure his equipment to monitor the nervous system was working. Then he left to go help other patients. The anesthesiologist administered the anesthesia perfectly and that was not the reason the surgery was botched anyways. So the neurosurgeon and anesthesiologist take it to court and lose. The doctor who was actually at fault settled for a nominal fee because he knew he botched it. That 19 year old kid got a 12 million dollars from the neurosurgeon and anesthesiologist. 12 million. He won the lottery. Getting that surgery was the best thing ever for him. My dad explained that doctors are careful (and this reminds me of the death star II contractor argument in clerks) in picking their patients because they're afraid of the system. Funny how that works.

quote:

Originally posted by The Friar:
Malpractice insurance for a practice can be $100,000 a year.

Actually, it can cost that and more for each, individual physician in a practice, depending on specialty, region of practice, and liability history.

quote:

Originally posted by The Friar:
My dad explained that doctors are careful (and this reminds me of the death star II contractor argument in clerks) in picking their patients because they're afraid of the system. Funny how that works.

Town, regions and states are losing physicians because of medical liability crises. Obstetrics and Neurosurgery are particularly hard hit, since they have such high premiums. Some states have award caps, or caps on awards specifically for pain and suffering, and these keep premiums more reasonable, but these are a minority of states.

Keep in mind that most physicians depend on CMS for the majority of their reimbursements (Medicare and Medicaid). In the last 15 years, reimbursements have been increased roughly 4%. Not 4% per year, 4% total. Have you had a raise of greater than 4% in the last 15 years? Over the next 5 years we are scheduled to see a decrease in reimbursement of at least 2.5%, unless Congress defers the scheduled rollback. In addition, medical liability has increased by approximately 150 to 300% over the last 5 years. Finally, most physicians are also small business owners, with overhead, rent, light, electrical bills, and employees to pay. My employees receive cost of living raises that come directly out of my margin.

By the way, the reimbursements are set centrally, and there is no negotiation with CMS. If we don't like it, we cannot organize, and we cannot strike.

John Edwards became a multi-millionaire, by carefully selecting which cases he would accept, and which he would not accept. He didn't waste time and effort on cases where he didn't expect a windfall. Since most cases in medical liability are handled on contingency, the lawyer only takes the cases he or she feels that s/he can win, and win big.

I have no such luxury. When I am called out of bed to see the uninsured motor vehicle accident victim in the middle of the night, I must do my very best to take care of him, whether he can pay me or not. He usually does not pay me. However, I am on the hook for medical liability exactly the same as I am for my best reimbursing patient. I don't complain about it, it is part of the oath I took. But who is really looking out for the little guy?


Ugh. I should probably hit the delete button right now. I enjoy doing what I do, and it's generally incredibly satisfying. My interactions with patients are usually very satisfying, and are the reason I continue. However, your doctor is getting squeezed on both ends. He or she may not be very happy for very much longer, and you probably ought to know why.

This debate is metacritic forums at their best.

Intelligent, reasoned and informed contributions all round.

Thanks for enlightening an Australian who, along with many of me countryfolk has been alarmed by the US model of health care creeping onto our shores and crawling into our hospitals and surgeries.

quote:

Originally posted by kendocubano:
Obstetrics and Neurosurgery are particularly hard hit, since they have such high premiums. Some states have award caps, or caps on awards specifically for pain and suffering, and these keep premiums more reasonable, but these are a minority of states.

This is the reason I've had so many neurosurgeons over the years. Many are moving to Kansas which is in the minority that you mention. I have actually been turned away because of my condition. They see me as a walking lawsuit.

This is good that the primary issue in here is health care. Hopefully (crossing my fingers) the American public is thinking the same thing. We can change things.

And I'm going to college next year as a pre med (and I do plan to go all the way). I enjoy helping people. I enjoy learning. About science. I don't care about the fucking money. It causes too many problems. I would be in favor, as a possible future doctor, of a socialized health care system.

Once you graduate Friar, move to Australia. We have a very fine health care system, and a monster lack of doctors.

I'll think about it. I do grow tired of Americans at times.
Personally, I wouldn't mind doing some sort of international work. Idk yet. I have to actually do well first.

quote:

Originally posted by The Friar:
I would be in favor, as a possible future doctor, of a socialized health care system.

I expect that we'll see some sort of nationalized healthcare reimbursement system in my lifetime. I expect it will mean less money for physicians, which doesn't entirely bother me. But, I think we'll have to see simultaneous tort reform for it to work.
However, as far as a full fledged NHS like one sees in GB, I'm not so sure I'd like that. I don't trust our government to manage hospitals.

Why? Spend some time trying to solve a problem at the post office, or talking to someone from the IRS. Better yet, spend a few months working in a VA hospital. That is what happens when the US government administers hospitals.*



*Before the response comes defending the VA hospital system let me tell you that I have met incredibly dedicated individuals working at VAs. Intelligent, determined, dedicated doctors, nurses, staff of all kinds. But most would tell you that they work in a dirty, wasteful, inefficient system, that places roadblocks at every turn. The wonder is that anything gets done, and it is remarkable that patient's get as good a care as they do.

So, dear American friends, what's new in the Presidential shenanigans? Mother Jones only tells me so much.

John McCain has cut back on his campaign staff, implying he's on the way out, but I said long ago that a 70+ year old guy will never be President. As difficult as it is for me to accept it (theoretically), I believe it'd be tougher for everybody else younger and/or older than me.

So, one down. Hilary is looking stronger every day it seems...

To use a Shakespearean exclamation,
"Oh, woe the day!"

Mark, if you're the perfect ages, then by all means, run! You have at least...um...50 supporters? O_O

In the south, where I live, everybody (well, maybe not everybody) but most not just hate Hilary Clinton but despise her. And of course they don't like black Obama (he's a terroist). They don't like Romney because he is a Mormon. So they like Giuliani the best down here. Funny thing is, he isn't really a pleasant cup of tea for the south. pro choice, limit gun control, disastrous personal life, little evidence of a strong faith (that's a big one ). I figured McCain would slowly gain momentum down here and overtake Giuliani. But, like Mark, said it looks like finances are getting to him. I just don't understand where this race is going.

However, I would like to open the discussion about the possibility of others running who have not said anything yet: Al Gore, Mike Bloomberg (interesting article in last weeks Newsweek. they're completely infatuated with little mikey), Fred Thompson and any others you guys are thinking.

Al Gore isn't running, unless some sort of global warming thing happens to make him some sort of Messiah.

I dread all of this. Every political primary is mere jockeying fo rposition, casting of aspersions, downright prevarication, best foot forward and all such.

I guess we have to do it because it is part of our process but I cannot stomach it. Yuck! Pls may we have a decent President this time? Fantasy!

No we may not. Because the only people that make it out of the primaries are hyper-polarizing, à la H. Clinton. The Republican candidate is a bible-thumping, gun-loving, truck-driving, pro-life, pro-capital-punishment, &c, &c...and each Democratic candidate is hyper-environmentalist, neo-socialist, pro-choice, anti-capital-punishment. Just because I happen to lean left doesn't mean I prefer one better. I could not vote for H. Clinton. ...Oh, could we please have another B. Clinton? Why should we care if he has an affair? They don't care about this in Europe.