Very good article.  There is a strange phenomenon in American society. Whether it be to insure bonds, homes from floods, planes from falling, or rain on a parade, there is the same thing--no federal law to regulate insurance companies.  Malpractice insurance is close to the heart of healthcare issues.  When HMOs captured the front door in doctor/patient relationships they also took on a major role in the malpractice question.  At least I've been told that.  Physicians with viable practices join "a group" for insurance reasons.  The fixes to the healthcare system since the 90s have, in my view, caused many people to have a hard time to have a real relationship with their doctors.  Now I'm reading reports of how medical students are not going into primary care.  No wonder.  It seems to me that in a few years one might be another person in a bullpen for an HMO.

Personally, I'm lucky, because I had a primary care doctor when I became old enough for Medicare.  However, during the early 90s, there was a chance I would move and didn't want to make a change unless I was sure I could have a patient/doctor arrangment.  I didn't move that far, but my doctor said  that some doctors were dropping their Medicare patients and others were not taking any new ones.  So I see this as impacting the elderly.  I wonder if this is the reason that "groups" are so prevalent.  If one wanted  good old vanilla brand of Medicare, I suppose it would be hard to get.  

by Margaret Bassett (45 articles, 2909 quicklinks, 42 diaries, 1851 comments [99 recommended, 0 rejected]) on Wednesday, Sep 10, 2008 at 9:37:53 PM

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Dear Ms Bassett, 

Thank you and sorry to take so long to write back. Thursdays are call days and they run on the long side.  You are correct about medical students and primary care. Students are attracted to the higher paying, less work intensive specialties. Seeing the way reimbursement has developed, you cannot blame them. 

Medicare is a good, though incomplete, product.  Its major problem is  funding. The demand for services has grown faster than the funding.  In trying to control costs, all they can think of doing is decreasing the payment for an office visit.  It’s somewhat akin to looking at the cost of producing and owning a car, and paying the mechanic less in order  to conserve resources.  The mechanic's fee is a small part of the total cost, and poor maintenance, as you know, has its own rewards. 

Non-socialized single payer universal healthcare is the best system for America and it must be freed from the perversion of the legal industry.

I hope that statement is not too dramatic.  

Good to Hear from You,

Mark Green

12Sept2008    

by Mark Green (9 articles, 0 quicklinks, 1 diaries, 35 comments) on Friday, Sep 12, 2008 at 9:51:06 PM

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This is a beautiful article.  I couldn't agree more.  A facet that you didn't touch on, but that compliments the tenor of what you put forth, is a new policy toward "misadventures" that is emerging in several hospitals.

Several medical institutions are now adopting an attitude of complete disclosure in order to curb their malpractice suits when medical mishaps occur.  In the past hospitals and doctors were told only say what the lawyers tell you to say.  While doctors and nurses may have wanted to let the patient or their families know what happened, what went wrong, and appologize, this was discouraged.  But what they are finding is, for the most part, that the patient's and families accept the appology.

Doctors and nurses are just as human as the patients they treat, and when given the opportunity to express the nature of the circumstances, assuming that there isn't a case of real negligence, the patients tend to understand that sometimes bad outcomes occur, and the reduction in malpractice claims moving forward is evidence that what patients and families really wanted in the first place is an appology and/or an explanation.

Funny, treat people like human beings, and they act humanely.

by InsuranceTeaseDOTcom (0 articles, 0 quicklinks, 0 diaries, 43 comments [3 recommended, 0 rejected]) on Thursday, Sep 11, 2008 at 12:18:53 AM

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Dear InsuranceTease, 

Your point on full disclosure is well taken.  We follow that policy at the hospital where I practice.  It generally goes well and seems appreciated.  

In terms of general mishaps in hospitals, the Institute of Health’s analysis of medication related deaths is way over estimated.  They will not disagree that in their study if a patient was given an extra Tylenol above the ordered amount (a medication error), then died of what ever reason, that patient was logged in the study as a medication associated death.  Cause and effect were not intended to be addressed.  They were tabulated from statistical associations. Now, errors do occur and through bar coding arm bands, medications, and procedure orders, we hope to have a zero medication/procedure error rate in our future.  Like you said, however, we cannot get away from being human and we have to figure out a better way to deal with that. 

Human beings acting humanely!  That’s a pretty neat concept. Work on it some and we can see if we can spark any interest. 

Mark Green

12Sept2008

by Mark Green (9 articles, 0 quicklinks, 1 diaries, 35 comments) on Friday, Sep 12, 2008 at 10:20:32 PM

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