Several prominent orthopaedic surgeons in South Florida believe that medical liability, or tort, reform could lower costs and improve patient care. Many physicians and surgeons, in fact, are concerned with the lack of medical liability reform in the proposals for national health care reform being discussed in Washington DC.
On the American Academy of Orthopaedic Surgeons Web site, Dr. Stuart Weinstein, past president of the AAOS and current chair of the Orthopaedic Political Action Committee, mentions that some of the unintended consequences as a result of the medical liability system include:- A decrease in access to care in a growing number of states and an increase in healthcare costs.
- Access is affected as physicians move their practices to states with lower liability rates and change their practice patterns to reduce or eliminate high-risk services.
- A fundamental change in doctor-patient relationships since many now adopt the attitude that “every patient as a potential lawsuit.”
“Im very concerned with this issue primarily because if we are going to reform healthcare and try to address the issue of providing care/coverage to all of those uninsured people, I think the best way to do it is to drive down the cost for everyone else,” says Dr. Alan Routman of Ft. Lauderdale.
Dr. Kevin Shrock, also of Ft. Lauderdale, agrees.
“As far as tort reform is concerned, nothing is being promoted,” he says. “The President feels that this is something that the legal system should be addressing. The situation is such that the attorneys have made the rules and the laws as they are applied to medical malpractice. They set them down and were faced with the rules being imposed upon us. Theres nothing we can do except be there in Congress trying to help rewrite the laws which, historically, has not been our greatest strength. Theyre still laying down the rules that favor themselves at the expense of physicians.”
Dr. Routman and Dr. Shrock both agree that tort reform could lead to lower healthcare costs.
“Thats the crux of the issue,” says Dr. Routman. “We order too many tests and over order imaging studies and expensive tests like MRI scans and CAT scans based on defensive medicine practices.”
So, as an example, Dr. Routman says imagine if 1,000 people go to the emergency room and complain of headaches. All of them will have a CAT scan or MRI scan of their head but there may be only one person that has a lesion on their head that is diagnosable on the scan.
“But we have to scan everyone to find the minuscule lesion and that is not cost-effective,” he says. “The cost-effective way to treat them is to treat them for their headaches and if they go away, like most do, you dont need to order tests. If the one person who has a headache that persists, you can order a test for that person, so you dont have to scan and radiate 999 others. If we didnt have to worry about getting sued, then we can wait and order the scans more appropriately for the people who really need it and not waste our money and time on everyone getting scans.”
Worry about being sued has caused many physicians and surgeons to alter their practice patterns. While some are practicing defensive medicine, others are restricting the types of patients they will see or simply avoiding patients with complex problems or patients perceived as litigious.
Dr. Shrock urges his fellow physicians and surgeons to take action and to talk to their local legislatures to make tort reform a key issue in the plan to reform the healthcare system.
“We may get a seat at the table if we can demonstrate that we are trying to be part of the solution,” he says. “Were trying to identify things that are wasteful in the system, and not just related to defensive medicine. If we can show ways to save money and implement ideas that can help make healthcare more efficient, then maybe we will get the chance to bring up the issue of tort reform with those people who have the power to include it in the discussion.”
