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Insurers, not just lawyers, inflict real
pain on doctors When you go to a doctor's office, you expect to be seen in a timely manner by a qualified professional. Your concern is your health, certainly not a distant issue such as the malpractice-insurance debate. It's an industry issue that doesn't affect you. Right? But consider: • Care is being affected. Doctors are rushing to see more patients to cover the costs of rising premiums. Much as a teacher is more effective in smaller classrooms, physicians are best with manageable caseloads. • Legal distractions are becoming more common. According to the American Medical Association (AMA), one in six physicians face a medical-liability claim each year. In high-risk specialties, the frequency rises. Now, many time-pressed doctors have even less time because of lawsuits. Yet 70% of the cases filed are found to be without merit. Patients should consider that a demoralized and distracted doctor is not an effective caretaker. And doctors must begin to "heal ourselves" by acknowledging that much of our anger toward lawyers is misplaced. The wrong message At a recent AMA meeting in Chicago, some doctors said they were going to refuse to care for malpractice attorneys. But physicians' anger is not an effective tool for change. Besides, insurance companies, not lawyers, determine the prohibitive malpractice-insurance rates while ensuring their own profitability. These skyrocketing rates, together with frivolous lawsuits, are sending the U.S. health care system into a predictable death spiral. Both must be addressed through reasonable reforms, not knee-jerk actions. If not, the patient will be the one to suffer. Doctors would be wiser to group together and devise our own insurance than to target lawyers. A plaintiff's attorney in New York has a proposal to create liability insurance for physicians. He believes premiums are so overinflated that he can market malpractice insurance at one-third the current price. If such a notion were indeed possible, it would indicate that insurance companies are more than covering their costs. Cost to patients What should matter most to the patient is that the frustration and animosity that envelope malpractice-beleaguered physicians, many of whom may have done no wrong, may affect their concentration or even the quality of care. Doctors have become defensive, forced to write copious notes on each patient and order unnecessary tests as ways to protect against lawsuits. No panacea exists for the malpractice dilemma, but a system of peer review in the courts and in hospitals would be a good start. Panels of experts in both venues could serve as a safeguard against frivolous lawsuits while ensuring that patients who have suffered true malpractice have their day in court. Current Michigan law shows how a panel can be a gatekeeper for malpractice actions. The law requires a review of all potential lawsuits before a mediation panel, which has two weeks to determine whether care has deviated from normal, accepted standards of practice. A patient may reject the panel's opinion, but then must pay the doctor's costs if the final verdict goes for the defendant. This disincentive helps to weed out frivolous suits. Finally, the government should restrict insurance companies. Premiums should be regulated, much as doctors' fees already are through managed care and Medicare. In order to heal the system, health care reform must begin by stopping the hemorrhaging caused by rising malpractice-insurance rates. The health care system must become less profit-driven, less punitive and more careful in identifying avoidable errors that really do hurt patients. The next time your doctor seems quiet in the exam room or offers short answers to your questions, think about malpractice rates, lawyers and insurers. And think about change. Marc Siegel, an internist, is a clinical associate professor at New York University Medical School |
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Copyright © 1990-2007 Marc K. Siegel, M.D. |
