Atul Gawande’s Bad Medicine
Two snippets from a New Yorker interview with Atul Gawande:
You are a general surgeon. How often can you anticipate being sued in your career?
The statistics say that I should expect to be sued about once every six years. Now, there is some evidence that if you’re a nice guy and communicate well with your patients you get sued less. It’s not because you’re a better doctor; it seems to be because patients feel more loyal to you.
I’d argue that being a nice guy and communicating well with your patients is being a better doctor. I’ve seen plenty of examples of the opposite.
Are American doctors in a tougher position than those in, say, Great Britain or Canada?
The major difference between malpractice here and in Great Britain and Canada turns out not to be in the number of lawsuits. At this point, the U.K. and Canada seem to be catching up with our rate of lawsuits. The big difference is that the awards are far smaller. This is partly because of the traditions of their court systems, but it’s also because they have universal health coverage. Patients in those systems already have their medical expenses covered for their lifetime, as well as some disability benefits. So malpractice awards are restricted to other costs—lost wages, or compensation for suffering, for example—and these are much smaller costs on the whole.
My emphasis. Because people in the US have no guarantee that they’ll have health insurance tomorrow, or next month, or next year (and their medical error may become a “pre-existing condition”), when they sue for malpractice, they sue not only for pain and suffering, but they also sue for the coverage of their lifetime medical expenses.
Don’t like malpractice, docs? Listen better, and support national health insurance.
Update: Is Gawande wrong about the numbers?
Not considering cost of living factors amongsst the U.S. and U.K. and Canada, which may have great influence, it is probably in the financial interest of physicians NOT to support a national healthcare system. Even with higher malpractice premiums the U.S. physician takes home on average more than his Canadian or U.K. counterpart.
Drops in physician imbursement are probably inevitable (as we’ve seen since the beginning of Medicare) but without at least the minimal forces driving insurance competition as it is (forces that would cease under a universal coverage plan) salary decreases would be much larger. Such is seen with physician income in countries with socialized medicine.
Since the physician opposition to malpractice lawsuits is largely financial (although there are other minor issues such as time and effort which must be put into frivolous defenses) it doesn’t seem like supporting a national health insurance plan solves the underlying problems which are driving physician calls for tort reform.
According to Dr. Gawande, malpractice costs are physicians’ #1 issue, not income.
Those who really advocate for national health insurance always point to the Canadian and UK systems. If you really examine the UK system, you will find that more and more British are buying private medical insurance because of the long waits and rationing of care. The waits for an appointment with a Canadian orthopedist or neurosurgeon can be over eight weeks. It may take as long as six months to get an MRI.
I would agree that something should be done about our system, but I doubt that US citizens are willing to put up with the rationing of care that would take place if a national health insurance program were instituted. Most of the countries that have national health insurance are finding it more and more difficult to cope with the costs. Close to home, we have seen the costs of Medicare and Medicaid soar in spite of significant cut backs in reimbursement. I received about $3300 for the last total hip replacement that I did, before I retired from surgery, in 1989. Orthopedists, today, are lucky to get $1500. You quote your Dr. Gawande as indicating that malpractice costs are physicians’ #1 concern, not income. I would disagree with that statement. There is no question but what physicians are concerned about the cost of malpractice insurance, but from my experience, most physicians are more concerned about their income.
To be sure, before any significant control over the costs of health care can be made, the malpractice issue has to be addressed. However, physicians could significantly slow the increase in those costs if they would listen to and examine their patients before sending them off a CT scan or an MRI, “to find out what is wrong.”
Unfortunately, we already have rationing of care in this country, Dr. Thompson, except it’s based on ability to pay.
Waiting times have also been improved in Canada, and the US also spends more than double what Canada spends per person on health care. And while you may think that Medicare costs have soared, they’ve actually increased less than costs have increased in the private sector.