I Am Not A Perp!

"I am not a crook." "I did not have sexual relations with that woman." Whenever someone in authority loudly proclaims their innocence, we believe like Shakespeare, that they "doth protest too much." Well, I am not a perp and you need to believe me.

I, along with almost one million doctors, over 2 million nurses, and almost 3 million allied health personnel resent being treated like perps (perpetrators). We are trying to help. Most of the time, we do help. Occasionally, we make mistakes. Sometimes patients suffer because of our mistakes. Sometimes they suffer even though we did all the right things, but never do we intend harm. We are not PERPS.

The reasoning behind our entire medical malpractice system is simple (and flawed): when a patient suffers an adverse outcome, it is because someone made a mistake. The solution: find the guilty party; punish him, her or it; and that takes care of that.

No, No, and No.

Facts:

• Most bad medical outcomes are due to lack of perfect answers for medical problems.
• Errors DO occur and some injure patients (many do not).
• Care providers are human and therefore can never be perfect.
• Most decisions by care providers (99+%) are correct but that <1% can still kill patients.
• Regulations intended to help and protect patients actually hurt them.

The system we have fails to:

1. Protect the patients;
2. Compensate patients who are injured.
3. Help the providers deliver care;
4. Encourage learning so the providers can improve patient outcomes.

I am not a perp but since you treat me like one, I must behave defensively. That is why we have defensive medicine: doing things to make the medical record look good rather than simply what the patient needs. That is why care providers try to avoid non-compliant or high-risk patients. When (not if) a bad outcome occurs, the care provider will be automatically held accountable; will be guilty until proven innocent...and never proven innocent; and will "pay the price."

If you want providers who are not defensive; if you want systematic protections; if you want financial help when you are injured; if you want continuously improving medical outcomes, you must demand a radical change in the whole medical malpractice system to a No-Fault approach.

Treating Providers like Perps Gets You What you Have Now.
Do You Like It? If not, change to a No-Fault system!

Comments

[TRConnie]

You are not a perp; nor are the vast majority of physicians, nurses and health care providers. However, if something goes wrong, the patient is looking at (sometimes) years of treatment and costs. The vicious circle of liability driving up costs driving up needless testing driving up excessive record-keeping is now a noose around my neck. I have health insurance, but I also have a family history that necessitates my physician looking at every possible zebra when she sees hoof prints. I am now at the point where I can't afford preventative care. If something were to go wrong, I would by-pass the doctor's office and head directly to bankruptcy court. The whole system is screwed. You are not a perp and I am not a lawsuit waiting to happen. If we could agree on that, maybe we could get somewhere.

[rini]

I believe that physicians are being squeezed by both the malpractice system and the medical and malpractice insurance systems.

Malpractice insurers should be regulated. The entire health insurance system should be overhauled. I, for one, think that most of us physicians made huge mistake in failing to support the idea of a single payer...years ago. Now insurers are fleecing the system at the expense of doctors and, unfortunately, patients.

I do agree that some malpractice cases have come to egregious conclusions and that physicians do feel under the gun, legally. The onus of documentation/paper work itself is ridiculous. We should not have to track down a patient who hasn't gone for a test that we ordered and remind them to get the test, repeatedly or be at risk of lawsuit if the patient has a bad outcome because of failure to get he test that they were told to get and given an order for.

Still, the best defense is to communicate well with your patients and let them know what to expect. Also, you cannot have a big ego. I never mind when a patient wants a second opinion. I welcome it.

So far, I've been lucky. I've been practicing for almost eleven years... no suits yet.

[PlaceboStudman]

Dr Waldman, speaking as a chronically disabled, and terminally ill man, I can say unequivocably, you are far from a perpetrator in the heinous crime that has become the medical system. If anything, you and your co-workers and associates have become the first line in the victimization of the American people, by greedy capitalistic people and organizations who care more about the bottom line and what lines their pockets than the actual health and welfare of its citizens. This country is being fleeced by HMO's, insurance companies, and the government's implicit involvement in not regulating the medical and medical records industry. It will only be until/unless we, the American people, the patients, along with and working beside their doctors and medical care providers take back our rights, and our money, and give us the choices of where to go, and what to do with our bodies and our pocketbooks that we will have any chance of making headway in resolving yet another one of Humanities greatest humanitarian crises that America has seen in many decades.

[wolfgangmo]

Excellent post Studman,

Here is another fact for the Waldman, a single payer system will alleviate your medical malpractice woes.

The main cost in malpractice costs in the US is ongoing treatments. Single payer will remove that obligation in lawsuits which will result in lowered malpractice premiums and fewer lawsuits filed. The main reason for lawsuits is that people need treatment.

The proof is in malpractice premium rates. Call an insurer in Canada, tell then you are thinking about moving to Canada and want a quote. Give them the same limits and coverages you currently have and prepare yourself to have your jaw hit the floor from shock. I did that for our clinic and the cost difference was huge.

So if you want to reform the system you need to advocate for single payer universal coverage and your "problem" will disappear.