Dr. Hossfeld is an assistant professor of emergency medicine at the University of Illinois‐Chicago. He is a past president of the Illinois College of Emergency Physicians, and has been involved in the legal side of emergency medicine for more than 25 years.
Health care reform? We're sick to death of the debate. Cliché after sound bite after jingle. For all the expert opinions, we sense none of them really know the issues. In fact, the statements of politicians, ivory tower physicians, and societal spokespersons don't ring true at all. It's the docs in the pits who really know the issues.
I couldn't put my finger on it for a long time. But when President Obama spoke to the American Medical Association in Chicago, and made the pronouncement that litigation reform was not part of the solution, I knew nothing good could come of it. Either he didn't have a clue what he was talking about or his party was just too beholden to the legal profession. For anyone not to realize that the whole medical profession has been terribly and probably irrevocably altered by the fear of medical lawsuits means that he is out of touch or on the wrong side to help.
That cover-yourself mindset didn't just appear without cause. Good doctors were accused, tried, and sentenced based on meritless, illogical cases again and again. In response, we began ordering more tests, more treatments, more admissions (“just to watch patients”) to minimize our exposure. It costs a lot of money, but no one ever calls to thank you for saving the nation's health care system money, do they? Lawyers and nonsense lawsuits aren't just part of the problem. Medical malpractice has become the greatest part of the problem. When we stopped doing the right thing for the patients and started worrying about our vulnerability to a legal system that operated on the greed principal, the die was cast.
How did we ever get into this mess? Medicine had operated effectively free of government influence for generations. There was an important passing of the torch from senior to junior. Young doctors were mentored by older ones. Internal reviews of quality had their place, but the inherent passion of physicians to do their absolute best for their patients was the proud tradition that guaranteed excellence. When this president accused us of scheming to “cut diabetic feet off to make thousands of dollars,” it showed how little he knew of doctors. More importantly, it showed how little he respected doctors.
Was it a need for insuring care for all that led the government to take over? Charity care used to be a given. It was an unwritten law that all doctors helped those who couldn't pay, the so-called deserving poor. Dispensed by individuals and charitable groups since the founding of this country, the system allowed the simply lazy to be cut off. Charity work was just part of the package. Not done because of fear of litigation or legal declaration. It was just the right thing to do, and it worked. My elder colleagues assure me that the poor and aged weren't dying on the sidewalks and in the gutters prior to Medicare and Medicaid.
We are scientists. We would love to help every ill person and save every patient, but we are also realists. As stewards of our limited resources, we know that it makes no sense to order 10,000 negative CT scans to find one patient with a subdural hematoma that we might be able to help. We know it is bad medicine to order chest x-rays and antibiotics on every patient with a cough in case one of them might have a bacterial pneumonia. We need to use those resources in the most cost-effective manner, get the biggest bang for the buck. It is craziness to do otherwise. Now that craziness has a name. It's called CYA.
Lunacy is what it has become. How did medicine become the province of politicians and attorneys who made statements like: “Defensive medicine? There are a lot of tests that have little or no risk. I want every last test that can possibly be done on me. I don't call that defensive medicine. I call that cautious medicine.” The inmates are running the asylum.
Even our allies are out of touch. Official estimates of the cost of defensive medicine are pitifully low. A good third of the patients I now see in my inner city ED don't belong there at all. Out of fear that one in a million drops dead after being deflected to our clinics or their primary care physicians, we see millions of them in the ED annually. That's part of the cost of defensive medicine, too. All things considered, more than 50 percent of all tests, procedures, treatments, and admissions are done for fear of litigation, not for patient care. Skeptical? Check out the percent of positive x-rays you ordered last shift.
Generations of doctors have trained in this CYA era. It's questionable if it can be reversed. One thing I know for sure. Want to cut health care costs dramatically? Want to do it in a way where patients win, taxpayers win, and even doctors win? Rein back the cancer of frivolous malpractice suits. Without it, there is no real intention to help the problem. The vast majority of honest, driven, altruistic doctors deserve no less. We need to fiercely demand it, loudly and repeatedly.
Don't believe it, Mr. Congressman? Come work a shift with me. And bring your calculator.
Attending Scientific Assembly?
EMN is on a mission to erase the stigma of being sued for malpractice. Stop by Booth 374 to share your malpractice story with Dr. Hossfeld, and receive an “I've Been Served” pin.
About You've Been Served
This column is dedicated to the thousands of committed physicians and other health care professionals, who despite their best efforts, devotion, and selfless lives committed to the best patient care, wound up in the defendant's chair on a malpractice suit. At best, I hope this column has an impact on litigation reform, abandoning the unrealistic, unattainable standard of care that has been set as perfection. At a minimum, I hope to serve as a sounding board for the countless professionals who have been subjected to personal attacks by the very patients we have vowed to help. — GH
Write to Dr. Hossfeld
Share your malpractice story by writing to Dr. Hossfeld at EMN@lww.com or meet him in person at EMN's booth (#374) at the ACEP Scientific Assembly.
© 2009 Lippincott Williams & Wilkins, Inc.