http://www.foxnews.com/story/0,2933,74423,00.html

The above news article is about Doctors in West Virginia not coming to work in protest of the malpractice problems and liabilities involved. While I am not a health care worker, it does appear to me that bureaucracy is taking over and new issues have come into the health care field.

What are the factors that have led to this? What can be done to correct these issues? Are we about to see a time come where there is a shortage of people going into the medical field due to the liability involved?

I think that there are a lot of issues involved. We didn't get bogged down with such a huge problem over night.

Here are a few of my speculations, not in any specific order of blame.

Lawsuits way out of range or reasonable based on both litigants pushing lawyers for more money and LAWYERS pushing the envelope BECAUSE THEY CAN!

Insurance companies increasing the rates of Liability to astronomical rates.

(Do you know that family practice doctors have to come up with almost $100,000 UP FRONT BEFORE they can start practicing, then during the year they have to come up with another $50,000? After that, Each years insurance is about $100-$150,000. They earn about $200,000 a year... and end up brining home about $50,000... AND this does NOT include paying back Medical school loans!)

HMO's say what meds and services they will pay for. The rediculous thing is medication companies make "deals" with the HMO's about what meds to authorize. For example, my HMO won't pay for a relatively inexpensive med, $10 a month, BUT the med that costs $600 a month they will pay for because of the "deal" with the medication company. Both meds DO the same thing equally as well. So,is this saving money? I don't think so.

Hospitals are also increasing THEIR costs, often partly in response THEIR increasing insurance costs. In my area there are about 4 major hospitals. Only ONE of them did NOT lose money during last years fiscal year.

Surgeons pay for the use of operating rooms, they pay the staffs wages IN that room, they pay for the use of the equipment within the room, and THEN they pay for the insurance premiums which are even HIGHER for surgeons.

There are no easy answers, but we have to get a grip on things before spiral out of control and we have no one willing to work as a physician OR a nurse.

It's not really accurate that surgeons pay for the use of the OR, or that a typical family doc pays 100K in malpractice. But it certainly is true that malpractice is a big and complex issue. As a surgeon, I am of course inclined to see the lawyers as a bigger problem than that of malpractice itself: the first problem is distinguishing malpractice (which I take to mean bad care) from bad outcomes, which can occur despite good care. Next is the legal system used to remedy the problem: there are "doctors" who do nothing but testify for money, and it's possible to find one who will say literally anything a lawyer is looking for. The result is that a judge can't just toss an obviously ridiculous case, because there's an "expert" on the other side willing to testify. So it must be adjudicated. And many insurance companies would rather pay to settle than risk an outrageous award. So the mere filing of a case has a fair chance of recovering money, much of which goes to the lawyer. It's not that malpractice doesn't occur; but from what I've seen, most lawsuits are about bad outcomes where the care itself was not improper. How to solve that? I'm not sure; however, I think having arbitration panels would be an improvement. Healthcare finance is a huge problem and malpractice costs are just a part. In general, the approach to rising costs has been only, in one form or another, to reduce payments to hospitals and doctors; whether through HMO (a misnomer if ever there was one) or regular insurance, or Medicare/Medicaid. There's only so much blood in the turnip. You can't fix a system by paying less and less to the providers. Doctors have to do more work to make less money; hospitals get less and less to pay nurses and other workers, and to provide care. I think it's true that a few years ago doctors were making too much money (my colleagues may not agree) but I really don't think so currently, in most cases. And nurses work too hard, have too little time for patients, have too many patients to care for properly. I think sooner or later we, as a society, will have to address how much we are willing to spend on healthcare, allocate the money, and decide on priorities. If we expect everyone to be able to have all care at any age under any circumstance, we'll have to expect to pay for it. Likewise, if we want to be able to see a doctor right away, get elective surgery within days (as we do in the US but not in most other countries) we'll have to expect to pay for that kind of service. If we are willing to openly or defacto (as in England and Canada) to ration care, and wait for care, then we can expect to reduce costs.....but no politico will have the guts to face such a hard reality. So I think where we're headed is toward attracting less dedicated people into the field. People who are willing to work hard and provide high quality care ought to be able to expect commensurate reward. It's no longer true. So we'll see a different sort choosing medicine; people who'll settle for mediocre care for mediocre reward.

I was reading about this in the paper today, and it is really sad that it came to this. I sort of understand their their situations though. I believe too many malpractice lawsuits are the main cause of this.

It seems to me that much of the health care field, hospitals & nursing homes are turning into more of a big business. Big bigness are considered to have deep pockets. In come the lawyers seeing what they can squeeze out.

I am not saying there shouldn't be some kind of accountability. And we all know health care is not an exact science. But I have to ask, should potential medical mistakes be determined in a court room? I tend to think there should be a mediating body of some kind in the system. Made up of professionals, doctors & nurses. They can very well be more critical than a court room with 12 jurors.

http://www.cnn.com/2003/HEALTH/01/02/doctors.strike/index.html

Here is an update to what I had posted yesterday. While this is a sad situation, perhaps sometimes people have to take drastic measures to get the point across that something is terribly wrong.