Medical Malpractice and Medicare: Meditations in Confusion

by Bradley Miller on September 28, 2009

I was reading a blog post from Dr Whitecoat about how reimbursement and the threat of malpractice lawsuits can drastically change the type of medical care we receive.  Previously, this doc wrote about his own malpractice trial and just how nerve racking and time consuming it was for him.  Clearly, through all 25 posts, he was rattled by the experience, and when that is combined with the time it took away from him you begin to understand just why these trials are such a deterrent and scary thing for docs.

But the post that got me to thinking this morning was one he wrote about an unconscious trauma patient whose care was clearly influenced by CYA and medicare reimbursement forces rather than proper medicine. Before I go on, I’d like to say that I think he practiced the right type of medicine – it’s just a sign of the times we live in and indeed why I thought of this post.

What I’d like to suggest is that it’s time to think about how the healthcare industry presents its reform arguments and how the industry creates confusion and that inhibits reform and advances.  Specifically, it feels like healthcare folks – whether docs or insurance execs or legislators – “cross the streams” in terms of arguments – they mix arguments that have no business being mixed – and that confuses the public and then stultifies the debate for reform.  Debate is good.  Ill informed and ill inspired debate is confusing and wrong – particularly in such a complex subject.  As long as Ghostbusters is being quoted, it feels like we’re creating one hell of a big twinkie of healthcare confusion.

In the case of the Whitecoat entry I’m thinking about how “proper medicine” gets crossed with healthcare savings argument in malpractice context.  I’m absolutely not saying Whitecoat is purposely mixing these concepts, rather it’s so commonplace that one cannot help but combine different arguments.

I’ll write more about it in the upcoming entries, but there’s a difference between cost effective healthcare/good medicine and then pre-emptive-CYA-avoid-a-lawsuit medicine, but those two contexts often get crossed and confused.  That maligns the argument and debate that we have as a public and then obscures the path to true and effective reform.I’m suggesting that it’s time that we start properly breaking down the argument and stop creating confusion to push specific interests in healthcare reform.  Some of this is conscious, some of it is unconscious, but regardless it confuses the debate.  We need to sit back, understand what we’re debating and hopefully that will help us come to a better ultimate reform.  Break the argument in to the proper chunks – don’t confuse excessive spending for malpractice CYA with proper and effective quality medicine.  But, I’m not holding my breath.  More to come.

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