Saturday, March 21, 2009

No "I" in Team...
Kevin points to a post by Duncan Cross in which he opines that the trial lawyers take care of our patients interests better than we do:
Now I don’t think trial lawyers are saints, but here’s the thing: when faced with their own mistakes, doctors can no longer be trusted to act in their patients’ interests. Trial lawyers may be working from craven self-interest, but that self-interest is better aligned with patients’ interests on this problem.

I must disagree, their self-interest is better aligned with their client's interest. Before you become their client, they have to believe that they can win and get enough money to make it worth their while. How do I know? Because they themselves say so.
Allen: Even before we request records, Alice and I will sit down and evaluate the case. The first thing we need to assess is the dollar value of the damage. If there's no damage, then there's no case for us, no matter how badly the doctor may have screwed up. I could be more compassionate about it, but that's the real basis for our decision: You establish the damage first, then the liability.

Burkin: Because of our time investment and costs, we really can't consider a case unless we can expect a payoff of at least $200,000 in damages, and even that's really not enough. If we end up taking the case to trial, we're probably going to spend $20,000 to $30,000 or more. So we have to make a business decision: Are the potential damages worth the time and expense we'll have to invest to win?

Q Isn't that a pretty cynical way to evaluate the claim of a badly injured patient?

Burkin: I'd say it's the only realistic way to do it, even though it's one of the sad things about the economics of this business. If the damage is, say, $50,000, that may be a big deal for many people, but it's not enough to make the case worthwhile for us. So we'll turn it down.
I also admit that physicians support tort reform out of "craven self interest". I do not enjoy paying an insurance premium higher than the average personal income in the U.S. But physicians also have concerns over access. If the only neurosurgeon within 100 miles gets sued enough and leaves, are the patients in that community better off or worse off? If liability concerns lead to closure of the maternity ward in a small-town hospital are those expectant mothers better off or worse off?

The commendable efforts that anesthesia made are also discussed in Dr. Cross' post.

I've discussed this before, and as per a commenter on my post:
I join the Journal in applauding our anesthesia colleagues in their success in increasing the safety of their profession. While reading the article yesterday, I was struck by the impression that the progress made was low hanging fruit; it describes that horrors that accompany esophageal intubation and then, voila, pulse-ox monitors and capnographs appeared, and now the problem has been virtually eliminated.

as well as Dr. Cross' post:
As it turns out, anesthesiology is well-suited to standardization. There are x number of drugs that can be administered to a person of y weight with a few variable multiplicands yielding a graph that one can pin on the wall as set standards. Much of medicine is not so simple.
The results that have been achieved with anesthesia may not be transferable to other specialties. Your mileage may vary.

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