CONTINUED: HEALTH CARE AN EVER ESCALATING CRISIS
HELLO, ONCE AGAIN EVERYONE ...
Below, is a previous posting, for which there were some cogent comments. Understandably, it has taken a bit of time - to find the time – to do their work - to have some medical–legal friend(s), and authorities consider your comments and answer towards them.
They and I respected and appreciated your questions, please respect their answers. This is, and must remain a dialogue between caring people.
Now, from previous blog postings, I know that these answers may not satisfy you the readers, nor answer your heartfelt concerns and questions. Causing you then, to ask more questions. I must say that this is such a complex area, and takes much time, and great knowledge to answer any question, if not to your satisfaction, at least as thoroughly as feasible, from the Respondents' position.
My point is, I hope you appreciate the time the Respondent(s) put into these answers, and with out “streaming”, I ask that you consider them, and reply respectfully, in a constructive dialectic open minded, learning manner.
We all have acutely personal vested interest(s) in the issues of healthcare facing all of us, and some, actually get to work diligently and directly on the solutions and/or the practice of it daily.
Your insights, and questions also can and are more often than not, most helpful, in effecting a positive change. The Respondent(s) I know appreciate hearing your concerns, and time permitting will endeavor to answer your questions.
Remember, we (The Reader(s) and the Respondent(s)) here on this blog, and within this issue are all on the same team.
Thank You for your constructive, non tendentious interactions, and interest.
don
:)
ORIGINAL POSTING: Friday, September 02, 2005
By Don Regan at: 7:50 PM
Health care is in an escalating crisis of historic proportions with the costs of healthcare distribution and insurance skyrocketing to over 1.6 trillion dollars, with no end in sight.
The medical malpractice crisis, although not insignificant, pales in the face of over 45 million uninsured Americans, many who are gainfully employed, and employers unable to meet the healthcare cost demands of their employees.
The time to stop issuing blame is over, and palliative measures must be recognized as only putting a band-aid over a bleeding aorta.
It is a time for real, long-term, solutions and difficult decisions: Centralized specialty care; patient assisted medical care payments; economy of scale treatments; greater attention to end of healthcare decisions; recognition of the human errors associated with medical care with a transition from litigation to remediation; improving communication openness and patient safety.
It is a time that healthcare providers and patients take responsibility for their tasks and situations, and remember that it is disease, not ourselves who we are fighting as a team. Attribution
********************************
Lompoc Lamb said...
Disposing of all of those lawyers would be a healthy start.A doctor can't afford to open a simple family practice without a fear of being litigated out of town by a lawyer in a cheap suit.Remember the character of the doctor on "Northern Exposure"? We need more of those in real life, but those times are long gone.
8:12 PM
- Lompoc lamb … Please keep in mind that although med mal is a major concern, it is less than 1% of the total health care expenditures (2002 - 110 billion for med mal out of 1.6 trillion for overall healthcare costs). It is true, however, that this impacts a small number of individuals, ~500,000 docs, and leads to expensive defensive medicine, but it is still not the lion's share of costs.
- In addition, lawyers do not, for the most part, chase after pt plaintiffs. In fact, only 1 out of 10 potential cases are accepted and there is an over 75% attrition rate of those taken by plaintiff attorneys. The literature and the IOM report point toward the fact that, because of legal defense costs and our anachronistic legal system, that many individuals who have suffered malpractice damage do not have cases that can support the costs of legal defense.
- Finally, the literature is clear that over 95% of all mal practice suits are based on communication and relational failures, not outcome! It becomes evident that we need to address physician communication (unrealistic expectations, misinformation, failure to apologize and take responsibility, etc) and dispute management skills, if we truly wish to reduce the malpractice suit frequency.
- Although it is internally satisfying, we must stop blaming attorneys, who simply represent clients who have contracted them for such services, for the ills of the healthcare world. Keep in mind that early conflict intervention programs and apology programs have reduced suits and increased patient safety overwhelmingly, but are rarely implemented, and do not exist in our county.
- One last thing, patients must understand that being ill creates a risk, and the more ill one is, and the higher the need for complicated care, the more likely they will experience medical error - this is a fact. Patient safety programs are being introduced to help reduce the error rates and improve outcome, but it is a team effort, an effort that directly involves the patient's input.
There are docs like in northern exposure, they are just buried in paper and beaurocracy. It is unfortunate that docs wear their frustrations on their sleeves, but make no mistake, they remain dedicated to their patients and steadfast to their oath to heal the sick.
******************************
NewsstandGreg said...
Doc,Great topic...but a two questions:What are the numbers in SLO county for medical malpractice suits? Somebody has the info for you as close as a phone call.How many people in SLO county are estimated to have no health insurance? Likewise, someone in the County government offices has that number for you also.If we keep some focus on the "local," we'll be more informative to our readers.
9:22 PM
- Newstandgreg … As for the stats, it is true that local figures are available, however, the impact of the uninsured and malpractice costs are not, in my mind, locally driven costs. As such I deal with healthcare distribution and conflict at the national level, but will gather that information for you, if you wish, or you could retrieve it and share it with us all.
- My reality is that even if our local uninsured rate is lower than the national average, we are still impacted by the costs expended nationally. The bottom line is this, we have spiraling premium rates with progressively larger numbers of uninsured, including the working uninsured. I know of no local action that will materially modify this trend nationally, and if available would only slow the tide of change for us in the central coast.
******************************
Spectator said...
I was listening to a speach by Newt the other day. He estimates that the amount of medicare fraud in New York, if stopped, would cut the cost to the population there by 50%. Have you looked at the statistics?
He also feels that a national database of patients and their medications would do a great deal to reduce expenses and death from perscription error. It would also wipe out multiple billing from fraudulent doctors. I agree with him on the database.
For replacement of medications, consider the refugees from New Orleans.
The time has come to hold the AMA accountable for policing the members of their own union. How do you feel about this union? Is it like the teachers union?It is time that unions went back to the time of guilds, where excellence was rewarded, and poor work was rewarded with expulsion.It is the socialistic nature of unions that is killing them.
I hear that one has a far better chance of being killed by a doctor or nurse mistake in a hospital than by gunshot or stabbing.
Blame is good! It contributes to discourse. Team? When you go to most doctors, you are in the hands of the Phillistines. Doctors through the AMA limit the amount of students going to medical schools to produce a shortage, and thus insure higher rewards because of lack of competition.
The government allows foreign trained Doctors to come to the US to counter this shortage. It is hard in many cases to communicate with them in English. Not to say that they are not good doctors.
Doctor is a respected word, but any PHD is a doctor. A lot of ignorant people do not know the difference between a PHD and a MD. And that is why we have people in turbans waving hands over people taking money for cures.Not that I do not believe in witch doctors. If they make you feel better, you are on the way towards recovery.
And then there is the question of the bloodsucking lawyers. Put a cap on their percentages above costs, and stop them from grossly inflating their office costs. 75 cents a copy? And boy, do they like to send copies!
It gives me great joy to see that lawyers have to buy malpractice insurance also.
But how do you find a lawyer to sue another lawyer when the judges are lawyers bound to protect lawyers and the whole "good old boy" legal system?
11:23 PM
- Spectator… Wow, lots of thoughts.
- I did not hear Newt's rendition of Medicare fraud, but I sense that he is a bit overstated. in addition, there is a huge difference between the allegation of Medicare fraud and that which is proven to be fraud. However, no doubt it exists and should not.
I am also not certain how another data base would be helpful in reducing rx costs and adverse outcomes, but I do support 100% the institution of computerized prescription software that checks for errors, creates a common data base for patients so that their medical information could be acquired by hospitals and healthcare providers. Such a system will markedly improve patient care and safety and is a major focus nationally, especially after the 1999 IOM (Inst of Medicine) study, To Err Is Human.
- I am unclear about your reference to the New Orleans crisis?
- The AMA is simply a trade and lobbying organization and has no authority over the practice of clinical medicine. However, the boards of specialties do set standards and guidelines and certainly the state medical board closely follows patient safety and quality management concerns. The AMA, like the state med societies, acts to lobby for physician rights and needs, along with being very proactive for patient treatment advances and safety protection. I have worked closely with the Calif Med Assoc, and can tell you without hesitation that these folks are true patient advocates, as well as physician advocates.
- The members are highly motivated and are dedicated to the improvement of not only physician interests, but the protection of patient care availability and quality. The problem is not the "union" in this case, but the falling membership that leads to less influence on the state and federal legislature. Docs see that things are getting worse, and attribute that partially to inaction of the medical societies. However, if if were not for the tireless work of these individuals the system that provides patients care, would be imploding at an even greater rate. Unfortunately, damage control is the best that they can do, at the present time.
-As for being "killed" by a doctor, I suggest that you read the IOM report and the Chaudry study of medical error. Docs are not murderers, nor are they the enemy. It is true that mistakes occur and, institutionally, at a level greater than we should experience. However, it must be understood that many of these errors are termed organizational errors, and are the product of patients with multi-system failures, undergoing complex treatment, with multiple healthcare providers (nurses, docs, resp. therapists, pharmacist, technicians, etc). Even at average care standards, the variables in such cases are so varied that mistakes are common.
Blame is not the answer, but acceptance of responsibility certainly is part of the solution. hence, there is a national movement to improve patient safety which includes computerized patient data bases and prescription programs, team based medical care, confidential reporting of errors and remedial care programs. I am very optimistic that
Blame is non-productive. I do not know any doc that purposely goes out to hurt his/her patient, but know many whose hearts have holes burnt into them when preventable harm does occur.
The culture of medicine is a complex study of behavior and exists as a zero tolerance for error community - tough gig!!! Punishment is not a good mechanism to broaden another's scope of practice, instead it intimidates one from admissions and corrections and creates an unhealthy attitude about facing responsibility. There is no question that the public must be protected from incompetent physicians, but there are not as many of them as there are good docs afraid to admit a mistake based on the impact on their career through the existing punitive systems, if they so acknowledge their shortfalls.
If you feel that you are in the hands of the philistines, then change hands - you are in charge of who cares for you, don't be a victim of your own indecision.
The AMA has no power to limit medical school numbers or admissions. There is no covert or insidious scheme to harm patients by setting up a false shortage of medical professionals.
In fact, medical such applications are falling because being a doc is becoming less and less appealing to young people and the "rewards" are certainly not $$$.
I will tell you factually, that my son elected to become a doc (after living with both my wife and myself, both docs, I am uncertain what was so attractive). He is now a 3rd resident out of a 6 yr program, is $250,000 in educational debt and although federal guidelines limit his work week to 85 hrs, is working well in excess of this. Yeh!, great life and lots of rewards - make no mistake on this either - it is dedication to people, and desire to be an aid to others that drive us, not the $$ which is, for the hours spent, quite modest in comparison.
- Yes, it is difficult to communicate with some FMG (Foreign Medical Graduates), and cultural differences occasionally become a barrier - and - yes they are often very good docs, but it is not a scheme to limit docs that bring them to the U.S., and the government does not actively recruit them. FMG's are more common in areas of lower reimbursement (rural), like our county, believe it or not (didn't think of us a rural, huh??) Want more docs here, no problem, convince your legislators to pay them like they get paid in Santa Barbara, and they will come. Like the movie "Field Of Dreams" - If you build it they will come - well here it is "if you pay them, they will come!"
I am a bit befuddled over the PhD, turban, hand waving commentary, but if it is in reference to alternative medicine, I have two things to say:
- 1. There are many methods to healing and although Alipathic methods are most favored and successful, you should not discount reputable alternative treatments that have been with us for centuries.
- 2. There are charlatans out there for sure, so, be smart and be aware - choose wisely.
As to the "blood-sucking" lawyers, please refer to my comments about med mal to lompoc lamb, above. Caps, although helpful and appropriate in reducing malpractice awards and subsequent insurance premiums, etc do not reduce the frequency of law suits.
People sue because they are unhappy or angry, not, in general, to make money - it is retribution not restitution that most often drives people to sue and an inability to get satisfaction outside of the litigated arena for their sensed injustice (some docs just don't do all that well at dealing with conflict). If you want to put the blood-sucking lawyers out of business? Remove the source of the suits: communication and personality dissatisfaction with medical care providers.
Most lawyers do have E&O insurance for professional negligence claims. There is a fundamental difference in medical and legal malpractice suits - in the latter, you must prove not only duty, breach, causation, and damage, but that the damage would not have otherwise occurred.
In other words … That but for the negligent action of the attorney … You would have won your case. And yes - it is unfair - you bet - so don't complain about it - help to change it.
Lawyers are not only, not bound to protect each other, but are serious competitors, and if contracted to sue another attorney for negligence will do so with full effort under the law. Judges, I can tell you, are not a part of any lawyer "good old boy" club. In fact, judges may no longer belong to the Bar Association as practicing attorneys. I may not always agree with their decisions, but they are not protectionists of their "own kind."
Below, is a previous posting, for which there were some cogent comments. Understandably, it has taken a bit of time - to find the time – to do their work - to have some medical–legal friend(s), and authorities consider your comments and answer towards them.
They and I respected and appreciated your questions, please respect their answers. This is, and must remain a dialogue between caring people.
Now, from previous blog postings, I know that these answers may not satisfy you the readers, nor answer your heartfelt concerns and questions. Causing you then, to ask more questions. I must say that this is such a complex area, and takes much time, and great knowledge to answer any question, if not to your satisfaction, at least as thoroughly as feasible, from the Respondents' position.
My point is, I hope you appreciate the time the Respondent(s) put into these answers, and with out “streaming”, I ask that you consider them, and reply respectfully, in a constructive dialectic open minded, learning manner.
We all have acutely personal vested interest(s) in the issues of healthcare facing all of us, and some, actually get to work diligently and directly on the solutions and/or the practice of it daily.
Your insights, and questions also can and are more often than not, most helpful, in effecting a positive change. The Respondent(s) I know appreciate hearing your concerns, and time permitting will endeavor to answer your questions.
Remember, we (The Reader(s) and the Respondent(s)) here on this blog, and within this issue are all on the same team.
Thank You for your constructive, non tendentious interactions, and interest.
don
:)
ORIGINAL POSTING: Friday, September 02, 2005
By Don Regan at: 7:50 PM
Health care is in an escalating crisis of historic proportions with the costs of healthcare distribution and insurance skyrocketing to over 1.6 trillion dollars, with no end in sight.
The medical malpractice crisis, although not insignificant, pales in the face of over 45 million uninsured Americans, many who are gainfully employed, and employers unable to meet the healthcare cost demands of their employees.
The time to stop issuing blame is over, and palliative measures must be recognized as only putting a band-aid over a bleeding aorta.
It is a time for real, long-term, solutions and difficult decisions: Centralized specialty care; patient assisted medical care payments; economy of scale treatments; greater attention to end of healthcare decisions; recognition of the human errors associated with medical care with a transition from litigation to remediation; improving communication openness and patient safety.
It is a time that healthcare providers and patients take responsibility for their tasks and situations, and remember that it is disease, not ourselves who we are fighting as a team. Attribution
********************************
Lompoc Lamb said...
Disposing of all of those lawyers would be a healthy start.A doctor can't afford to open a simple family practice without a fear of being litigated out of town by a lawyer in a cheap suit.Remember the character of the doctor on "Northern Exposure"? We need more of those in real life, but those times are long gone.
8:12 PM
- Lompoc lamb … Please keep in mind that although med mal is a major concern, it is less than 1% of the total health care expenditures (2002 - 110 billion for med mal out of 1.6 trillion for overall healthcare costs). It is true, however, that this impacts a small number of individuals, ~500,000 docs, and leads to expensive defensive medicine, but it is still not the lion's share of costs.
- In addition, lawyers do not, for the most part, chase after pt plaintiffs. In fact, only 1 out of 10 potential cases are accepted and there is an over 75% attrition rate of those taken by plaintiff attorneys. The literature and the IOM report point toward the fact that, because of legal defense costs and our anachronistic legal system, that many individuals who have suffered malpractice damage do not have cases that can support the costs of legal defense.
- Finally, the literature is clear that over 95% of all mal practice suits are based on communication and relational failures, not outcome! It becomes evident that we need to address physician communication (unrealistic expectations, misinformation, failure to apologize and take responsibility, etc) and dispute management skills, if we truly wish to reduce the malpractice suit frequency.
- Although it is internally satisfying, we must stop blaming attorneys, who simply represent clients who have contracted them for such services, for the ills of the healthcare world. Keep in mind that early conflict intervention programs and apology programs have reduced suits and increased patient safety overwhelmingly, but are rarely implemented, and do not exist in our county.
- One last thing, patients must understand that being ill creates a risk, and the more ill one is, and the higher the need for complicated care, the more likely they will experience medical error - this is a fact. Patient safety programs are being introduced to help reduce the error rates and improve outcome, but it is a team effort, an effort that directly involves the patient's input.
There are docs like in northern exposure, they are just buried in paper and beaurocracy. It is unfortunate that docs wear their frustrations on their sleeves, but make no mistake, they remain dedicated to their patients and steadfast to their oath to heal the sick.
******************************
NewsstandGreg said...
Doc,Great topic...but a two questions:What are the numbers in SLO county for medical malpractice suits? Somebody has the info for you as close as a phone call.How many people in SLO county are estimated to have no health insurance? Likewise, someone in the County government offices has that number for you also.If we keep some focus on the "local," we'll be more informative to our readers.
9:22 PM
- Newstandgreg … As for the stats, it is true that local figures are available, however, the impact of the uninsured and malpractice costs are not, in my mind, locally driven costs. As such I deal with healthcare distribution and conflict at the national level, but will gather that information for you, if you wish, or you could retrieve it and share it with us all.
- My reality is that even if our local uninsured rate is lower than the national average, we are still impacted by the costs expended nationally. The bottom line is this, we have spiraling premium rates with progressively larger numbers of uninsured, including the working uninsured. I know of no local action that will materially modify this trend nationally, and if available would only slow the tide of change for us in the central coast.
******************************
Spectator said...
I was listening to a speach by Newt the other day. He estimates that the amount of medicare fraud in New York, if stopped, would cut the cost to the population there by 50%. Have you looked at the statistics?
He also feels that a national database of patients and their medications would do a great deal to reduce expenses and death from perscription error. It would also wipe out multiple billing from fraudulent doctors. I agree with him on the database.
For replacement of medications, consider the refugees from New Orleans.
The time has come to hold the AMA accountable for policing the members of their own union. How do you feel about this union? Is it like the teachers union?It is time that unions went back to the time of guilds, where excellence was rewarded, and poor work was rewarded with expulsion.It is the socialistic nature of unions that is killing them.
I hear that one has a far better chance of being killed by a doctor or nurse mistake in a hospital than by gunshot or stabbing.
Blame is good! It contributes to discourse. Team? When you go to most doctors, you are in the hands of the Phillistines. Doctors through the AMA limit the amount of students going to medical schools to produce a shortage, and thus insure higher rewards because of lack of competition.
The government allows foreign trained Doctors to come to the US to counter this shortage. It is hard in many cases to communicate with them in English. Not to say that they are not good doctors.
Doctor is a respected word, but any PHD is a doctor. A lot of ignorant people do not know the difference between a PHD and a MD. And that is why we have people in turbans waving hands over people taking money for cures.Not that I do not believe in witch doctors. If they make you feel better, you are on the way towards recovery.
And then there is the question of the bloodsucking lawyers. Put a cap on their percentages above costs, and stop them from grossly inflating their office costs. 75 cents a copy? And boy, do they like to send copies!
It gives me great joy to see that lawyers have to buy malpractice insurance also.
But how do you find a lawyer to sue another lawyer when the judges are lawyers bound to protect lawyers and the whole "good old boy" legal system?
11:23 PM
- Spectator… Wow, lots of thoughts.
- I did not hear Newt's rendition of Medicare fraud, but I sense that he is a bit overstated. in addition, there is a huge difference between the allegation of Medicare fraud and that which is proven to be fraud. However, no doubt it exists and should not.
I am also not certain how another data base would be helpful in reducing rx costs and adverse outcomes, but I do support 100% the institution of computerized prescription software that checks for errors, creates a common data base for patients so that their medical information could be acquired by hospitals and healthcare providers. Such a system will markedly improve patient care and safety and is a major focus nationally, especially after the 1999 IOM (Inst of Medicine) study, To Err Is Human.
- I am unclear about your reference to the New Orleans crisis?
- The AMA is simply a trade and lobbying organization and has no authority over the practice of clinical medicine. However, the boards of specialties do set standards and guidelines and certainly the state medical board closely follows patient safety and quality management concerns. The AMA, like the state med societies, acts to lobby for physician rights and needs, along with being very proactive for patient treatment advances and safety protection. I have worked closely with the Calif Med Assoc, and can tell you without hesitation that these folks are true patient advocates, as well as physician advocates.
- The members are highly motivated and are dedicated to the improvement of not only physician interests, but the protection of patient care availability and quality. The problem is not the "union" in this case, but the falling membership that leads to less influence on the state and federal legislature. Docs see that things are getting worse, and attribute that partially to inaction of the medical societies. However, if if were not for the tireless work of these individuals the system that provides patients care, would be imploding at an even greater rate. Unfortunately, damage control is the best that they can do, at the present time.
-As for being "killed" by a doctor, I suggest that you read the IOM report and the Chaudry study of medical error. Docs are not murderers, nor are they the enemy. It is true that mistakes occur and, institutionally, at a level greater than we should experience. However, it must be understood that many of these errors are termed organizational errors, and are the product of patients with multi-system failures, undergoing complex treatment, with multiple healthcare providers (nurses, docs, resp. therapists, pharmacist, technicians, etc). Even at average care standards, the variables in such cases are so varied that mistakes are common.
Blame is not the answer, but acceptance of responsibility certainly is part of the solution. hence, there is a national movement to improve patient safety which includes computerized patient data bases and prescription programs, team based medical care, confidential reporting of errors and remedial care programs. I am very optimistic that
Blame is non-productive. I do not know any doc that purposely goes out to hurt his/her patient, but know many whose hearts have holes burnt into them when preventable harm does occur.
The culture of medicine is a complex study of behavior and exists as a zero tolerance for error community - tough gig!!! Punishment is not a good mechanism to broaden another's scope of practice, instead it intimidates one from admissions and corrections and creates an unhealthy attitude about facing responsibility. There is no question that the public must be protected from incompetent physicians, but there are not as many of them as there are good docs afraid to admit a mistake based on the impact on their career through the existing punitive systems, if they so acknowledge their shortfalls.
If you feel that you are in the hands of the philistines, then change hands - you are in charge of who cares for you, don't be a victim of your own indecision.
The AMA has no power to limit medical school numbers or admissions. There is no covert or insidious scheme to harm patients by setting up a false shortage of medical professionals.
In fact, medical such applications are falling because being a doc is becoming less and less appealing to young people and the "rewards" are certainly not $$$.
I will tell you factually, that my son elected to become a doc (after living with both my wife and myself, both docs, I am uncertain what was so attractive). He is now a 3rd resident out of a 6 yr program, is $250,000 in educational debt and although federal guidelines limit his work week to 85 hrs, is working well in excess of this. Yeh!, great life and lots of rewards - make no mistake on this either - it is dedication to people, and desire to be an aid to others that drive us, not the $$ which is, for the hours spent, quite modest in comparison.
- Yes, it is difficult to communicate with some FMG (Foreign Medical Graduates), and cultural differences occasionally become a barrier - and - yes they are often very good docs, but it is not a scheme to limit docs that bring them to the U.S., and the government does not actively recruit them. FMG's are more common in areas of lower reimbursement (rural), like our county, believe it or not (didn't think of us a rural, huh??) Want more docs here, no problem, convince your legislators to pay them like they get paid in Santa Barbara, and they will come. Like the movie "Field Of Dreams" - If you build it they will come - well here it is "if you pay them, they will come!"
I am a bit befuddled over the PhD, turban, hand waving commentary, but if it is in reference to alternative medicine, I have two things to say:
- 1. There are many methods to healing and although Alipathic methods are most favored and successful, you should not discount reputable alternative treatments that have been with us for centuries.
- 2. There are charlatans out there for sure, so, be smart and be aware - choose wisely.
As to the "blood-sucking" lawyers, please refer to my comments about med mal to lompoc lamb, above. Caps, although helpful and appropriate in reducing malpractice awards and subsequent insurance premiums, etc do not reduce the frequency of law suits.
People sue because they are unhappy or angry, not, in general, to make money - it is retribution not restitution that most often drives people to sue and an inability to get satisfaction outside of the litigated arena for their sensed injustice (some docs just don't do all that well at dealing with conflict). If you want to put the blood-sucking lawyers out of business? Remove the source of the suits: communication and personality dissatisfaction with medical care providers.
Most lawyers do have E&O insurance for professional negligence claims. There is a fundamental difference in medical and legal malpractice suits - in the latter, you must prove not only duty, breach, causation, and damage, but that the damage would not have otherwise occurred.
In other words … That but for the negligent action of the attorney … You would have won your case. And yes - it is unfair - you bet - so don't complain about it - help to change it.
Lawyers are not only, not bound to protect each other, but are serious competitors, and if contracted to sue another attorney for negligence will do so with full effort under the law. Judges, I can tell you, are not a part of any lawyer "good old boy" club. In fact, judges may no longer belong to the Bar Association as practicing attorneys. I may not always agree with their decisions, but they are not protectionists of their "own kind."
posted by don regan at 8:07 AM
6 Comments:
AND OF COURSE VOTE FOR DOCTORS... WHO RUN FOR CONGRESS. IT GOES WITHOUT SAYING, SPECTATOR....
don
:)
Don,
Thanks for your answer, but if a voter checks the box to elect you, you will be representing this local area.
You'll also be representing some unknown percentage of uninsured residents. How many actual constituents is that?
What will you do for them if you're only concerned with what happens at the "national level?"
This comment has been removed by a blog administrator.
This comment has been removed by a blog administrator.
Thank you Greg, for your follow up. It is appreciated given the effort put forth by my friends to comprehensively reply, to each of the respondents, yourself included.
As you have mentioned, now twice, about local statistics, it would seem to me, you are telling me that you are not likely to take up my colleagues’ suggestion, that you yourself, personally, investigate the numbers you discuss, and then present them yourself, to us, and the readers.
That of course would be greatly appreciated, not only as a time saver for us, but by you doing so, it would make it more objective, and likely to be more credible.
I understand your reluctance to do so, and in fact, more probably we could run these down, ourselves, but with some equal effort.
I will endeavor to do so, but do not promise success, and if so, I can not predict any immediate time frame.
But … and in the meantime, and equally important, if not more important, is the statements and extensive explanations, you may have missed, which is, that whatever those numbers are, they are unlikely to shed any real informational solutions, on the already self evident problems, which are and have been so well defined and discussed nationally.
The explanations previously and herein, in answer to your question, were and are not an attempt to circumvent your concerns, but to say to you, that whatever the local numbers, our local problems are no different here “generally”, than elsewhere.
The specific details locally, while possibly idiosyncratic to our local medical-political environment, in fact is as likely to reflect, to a greater and lesser degree, problems facing everyone, everywhere here, and across our Nation.
And certainly, exemplified issues such as drug prices, Medicare, secondary insurance benefits, are all part and parcel of a larger national problem, or possibly societal visionary misunderstanding, if you will.
Therefore your Statement: "What will you do for them if you're only concerned with what happens at the "national level?"
This untidy reproach, that I am somehow “only concerned about the National level”, is in my mind somewhat disingenuous, unnecessary and absolutely incorrect.
All that the “attributed” generous replies were trying to say, on my behalf, to you, and other readers, was that the specific numbers, while perhaps interesting , are not, by themselves, helpful, in coming to solutions, here locally, anymore than anywhere else.
It doesn’t take local numbers to identify or prove this problem, as being real, and imminent. Nor create a need or ideas for workable solutions. It takes only one instance, and there are many locally, and nationally, as we all well know.
We certainly do have our health care issues here to be sure, and they need and have needed addressing. Many of those issues are approachable, and possibly most solvable, and done so by local patients working with their local Care Providers.
Please remember that not only the Patients have been victimized by health care beaurocracies, public and private, but destructively too, have been the very health care providers themselves, who now are forced to scramble for a living, and pay off enormous educational and business debts.
Your next Statement: "You'll also be representing some unknown percentage of uninsured residents. How many actual constituents is that?"
Whatever the number, Greg, what is important, is that it is most probably increasing, and concerns for accessible, affordable, inclusionary medical care incorporates this and all groups, within the aggregate known as health care services. In this Congressional District that would be @685,000 constituents, within the District.
More to the point … regardless of the increasing number of those needing, or in jeopardy of not receiving patient care (for many reasons, economic being only one, and a big one) … more typically than not, it is the local business person/practitioner, who sees the need, and solves the problem, simply, directly, and in a manner, which is economically feasible for all concerned, in an environment of inclusionary personal care, safety, security, and accessibility.
I have never seen (And believe whole heartedly that I will never see.) the public sector (Government or the Courts) solve anything, effectively or efficiently. If they do address an issue, such public intervention typically and simply always and only further complicates it, and drives it further out of reach with added confrontational beaurocracy; middlemen; income redistribution to the distributor network, rather than the provider and patient; over regulation, and all resulting in significantly increased costs, decreased savings and efficiencies, and prohibitive – interruptive complexities delaying and further excluding acute and long term care to and for the medical services consumer.
The net result always being more expense to, and less control for the consumer, who increasingly sees themselves the victim, rather than the recipient.
This adversarial confrontational care giver vs. consumer relationship is at the root/heart of the problem. Both sides feeling, and believing contrastively, that they are victimized, disrespected, and abused by the other, and more importantly by the “System”. Of course with too infrequent oases of mutual satisfaction, and personal gratification.
While it seems simplistic, Greg, the answer is direct one on one “Communication”. Communication between the Care Provider of care and the Consumer of care -- i.e. Care Consumer).
I use the word Consumer, intentionally, rather than patient, as Consumer is more empowering on behalf of the recipient. It is less a position of entitlement and victim, to one of assertive and analytic recipient of services, as one would hope and intend is the case in any other equitable retail consumer-service relationship.
The answer, in my mind is not in increased government spending, or beaurocratic controls, or regulatory overkill. It is best remembered that just as in learning which is best when it is solely between the teacher, the student, and the parents, in medicine it is the same intimate triangular loop. Anymore vested interests than that, for whatever the reason, just muddies the water.
Each are/must be, equal and equally responsible, to fulfill their mutual commitment, their end of the “understood” personally contracted bargain.
I personally am quite hopeful with the “potential” of: Patient Access, Advocacy, Care and Treatment Practices (P.A.C.T.s). In this idealized practice format, the providers’ office assists the patient with comprehensive health care, from counseling and assistance in the selection, acquisition, and enrollment of supportive and affordable health and drug insurance programs, thru to the delivery of and follow-up to care service provision, both within and without the practice. They are truly the hub of the health care wheel, and together with the patient, monitor referrals, and follow-up care.
They are the consumer’s primary service care patient advocates.
These are becoming more in vogue, as we talk. They are generally accessed by an annual membership, which provides the patient with direct and accessible, immediate care by the health care provider(s) of their actual choice, under a personal contract between both parties.
This is in my mind, a real potential solution for the increasing alienating service formats we have out there now, where patients, don’t get services, and Doctors don’t get paid, and both are misunderstood and alienated, in a system, as we have seen, which is otherwise disintegrating in front of our very eyes.
We’ve got to bring the Doctor and the Patient/Consumer back together, as members of the same team/family working with and for each other’s best health interests.
This offers one of the best hopes for inclusionary medicine for all citizens. There are challenges and potential problems, as there are for all things, but it does one thing, that no one else can do, and that is bring direct medical care back to and between the Care giver and the Care recipient.
By taking out the Middle men, attorneys, rest assured, there will be many third beaurocratic parties and parasites, who will squeal, as they are moved out of the control position, that they are now sadly and destructively entrenched within.
But while they lose, it will be the patient who will most certainly win, by being back in control in personal and direct partnership with their sustainable healthy health care provider relationship.
Questions, or speeches?
Don
:)
Health care is coming to an escalating crisis and something must be done to improve health care.
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