I Don't Agree With Everything

So far my posts have been all positive, concerning health care reform. But there are two things, that President Obama, proposed that I do not agree with. One is tort reform, and the other is how to pay for it. Today will be tort reform. In case you are unsure a tort basically refers to a citizen's ability to sue for damages, for medical mistakes, also called medical malpractice. Let me say first, I am in no way against people being able to sue for gross negligence in the medical field. Nor am I saying I am against doctors, nurses, hospitals, or nursing homes. That is the furthest from the truth. Every year, or two, we have to take a nursing continuing education course, on medical errors. These classes are a collection of statistics, and ways to improve medical errors in the profession. One sentence jumped out at me more than any other. It said that the number one reason for the extremely high cost of health care, is because of lawsuits, risk, and malpractice issues. So what does that tell you, that the lawyers need to be removed from the equation, or at least limited. Now Obama said he did not believe in capping the recovery amount a jury can award a plaintiff. Ok, fine then make changes some other way. Honestly I am not sure what he can really do at the federal level, as tort laws are left up to the individual states, but there must be something. Here are some of my thoughts on this issue. Some of these may sound harsh, but lets be frank, it is true.

1- Lawyers should not be allowed to have commercials trolling for clients. Every single time there is even a whiff of something with a medication, or instrument, they are trolling for customers. I think we can agree most people would know how to sue, without constant commercials asking them if they used this, or took this, or did this happen to them. These lawyers are making a killing, because even if the case never goes to trial, and is settled out of court which most are, they are still getting at least 30% of the settlement amount. I am still waiting for the Zicam ads to start.

2- Doctors need to be doctors, and do what doctors do. Physicians assistants should be banned. I do not see any reason for someone who goes to school for less than two years sometimes, to be allowed to write prescriptions for medications. I will not even see a PA, they just push drugs on you. Doctors need to spend more time with their patients. Come on now, you charge 180 dollars for a 15 min visit, if you even see them that long. Most times it is in, and out so fast, the patient can not discuss anything if they want to. If they think of something later, and call the office, you will most likely talk to the secretary, or maybe the nurse. These are all things that increase risk, and thereby increase the chance for lawsuits. If you don't want to be charged high malpractice rates, then decrease your risk. I heard a different Dr several times this week, state on TV, that they order tests that are not needed, because they are afraid to be sued. I am sorry I thought all procedures had to be justified, for the insurance company to cover them, so what the pt is stuck paying for them? Come on this is absurd.

3- The public needs to be informed, and educated, but not crazy. No one is perfect. Anytime you have a procedure done, or put a medication in your body, you are taking a risk for a side effect, or untoward event to occur. That does not mean it was malpractice. You need to learn about everything you have done, or take, and decide to assume the risk. If you did not ask the doctor, nurse, pharmacist or any other information source, and then something happens, you are part of the responsibility. Now obviously there are cases of gross negligence, and malpractice that the public has no control over, those are lawsuits, that should be brought.

4- Facilities that provide medical care, need to provide proper staffing ratios, proper training, and machines in good working order. Now this does not mean you need to spend billions buying new equipment every year, but it should be properly maintained, and in good working order. There are already laws on the books for this, but I think we can agree it doesn't mean it is followed, or enforced. Nurses often work with staffing numbers that are inadequate, and sometimes pushed into areas they are not trained, or comfortable with. I especially call on Mr Obama to change the ratios for nursing homes. Right now one nurse can have 30 patients on the first two shifts, and 40 on the night shift. One CNA, can have up to 19 patients, on the night shift. Now I am not saying I am against working hard, however to reduce risk of malpractice, you need to remove the risk. Having 30-40 patients is a risk, believe me, to everyone. The hospitals have more reasonable ratios, or at least they used to. It was based on acuity, and staffed as such. However with a nursing shortage, it may be short staffing there as well. Having nurses who are forced to work double shifts, short staffing, and in a highly stressful environment you can see how mistakes can happen. Some facilities have excellent competancy classes, each year, to be sure their staff is up to date, on new information, and skills. Others are not as good, and they increase the risk for everyone else, there by increasing the malpractice insurance for all. Nurses also need to know their Nurse Practice Act, and be willing to stand their ground, for what is safe, correct, and best for the patient, nurse, and facility.

I think medical malpractice insurance, should be based on a facility, or medical practice, on a base by base situation. If a Dr has low scores in all the things a DR should do to maintain being a good doctor, then they should pay more. If a Dr has higher scores, with very little risk mounted up, then they should pay less. Same goes for facilities. I do think there should be a cap on certain types of lawsuits, so that suing will be discouraged rather than encouraged. I think lawyers should be limited to how much money they can spend on advertising to troll for malpractice clients.

If we do not get some of the risk removed from health care, and bring down costs, who is to say it will not go the way of the housing bubble. One day it will just become too much, and explode. Then what will happen? I hate to even think about it. Health care is a team effort including, doctors, nurses, patients, and facilities, and everyone has a responsibility to each other.