General medical insurance is not the only issue causing problems for our health care system. Costs are also being driven up by doctors practicing defensive medicine and ordering large numbers of unnecessary tests to protect themselves from lawsuits. Even when doctors perform all necessary tests, patients are still able to sue for damages if something goes awry.
For example, a close family friend of ours is a general practitioner. Four years ago he saw a patient who was at high risk for a stroke, and he recommended the patient stay in the hospital overnight for observation. The patient politely declined, and returned home. The next day the patient returned to the hospital in an ambulance, mid-stroke. The patient was admitted into the hospital, treated, and eventually returned home perfectly fine. He did not have any long-term damage from the stroke, and was immediately put on blood thinners and modified his diet and exercise regimen. Not long after the patient returned home, our friend was summoned to court for a malpractice suit. The patient claimed that the stroke was the physician's fault, and that he should have forced him to remain in the hospital overnight. Again, the patient had no long-term damage, no Palsy, nothing except a slight scare and a large medical bill. Initially, the case was thrown out for being frivolous. Our friend believed that the suit was over, and he would be fine minus some legal bills. Four years later the patient again summoned him to court, with new lawyers and before a new judge. The judge accepted the case, and warned our friend to get a good lawyer. Our friend was forced to take a week off from work (thus reducing his usual paycheck by 1/4), hire a lawyer, and begin the process of defending himself for something that was completely ridiculous. The former patient was demanding $500,000 in damages, to compensate him for medical costs, his lawyers, and any emotional damage he may have suffered. Recently, the court again stated that the case was frivolous and threw it out, but our friend still had to incur legal bills for four years, an increase in his malpractice insurance premiums, and the loss of a full week of work (about 80 hours).
Given this example, how can doctors act beneficently when their fear of what may happen if something goes wrong overrides their concern for a patient? Should there be restrictions within the legal system on what is an appropriate malpractice suit?
(Submitted by Leslie Baggeson)
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Although it is difficult to define what is acceptable for a malpractice suit and what is not, I think there should be restrictions within the legal system on what is an appropriate malpractice suit. The costs for receiving an type of health care is extremely high causing patients to seek an alternative way for money compensation. For any little thing that can go wrong in a patient's eyes, a patient can sue the doctor for money. Both of my parents are pharmacists and I have witnessed, through their accounts, frivolous malpractice claims. If a medicine causes a certain side effect, a patient would still sue for malpractice. The patient should be warned before taking the pill of the side effects; it is not a pharmacists fault that the patient had to endure unrelated sicknesses. I think that due to human greed malpractice lawsuits will always occur, even if restrictions on them are made. I think that doctor's should not hinder their abilities to heal because of the fear of being sued. Although it is unfortunate that a doctor's willingness to help can lead to loss of money and a lawsuit, a doctor's job is to act beneficently. Every job has a risk of provoking a law suit; that does not mean that a person should stop performing their job at their best ability because of that risk. I believe that the only way to stop malpractice lawsuits is to limit them. Especially with the example that was given above, if a suit was thrown out because it was frivolous once, it should not be looked at again. Sometimes complications occur that a doctor did not intend to force upon a patient, however, the risk of these complications occurring should not stop a doctor from trying their hardest to help the sick.
ReplyDeleteThis situation provides a clear example of what can go wrong when a patient claims that a physician did not act beneficently toward them. It would be interesting, though, to examine what would have happened had the patient heeded the physician’s advice to remain in the hospital overnight. In this case, the patient would have been better off, being in the hospital when the stroke occurred. But what if the patient stayed in the hospital and ended up not having a stroke? And what if this happened often and with a variety of medical interventions? While legal costs and loss of work time are important factors for doctors who want to avoid medical malpractice suits, we should also recognize that attempting to avoid medical malpractice suits can raise costs by leading to an overuse of healthcare.
ReplyDeleteIs it possible to act too beneficently? If unnecessary procedures are used to avoid any possible chance of adverse event, and possible medical malpractice suit, do we end up harming consumers of healthcare by raising costs? This is a complicated question, but I think it corresponds with a need for limits on malpractice suits. There are obvious cases in which medical malpractice suits are warranted. However, too many malpractice suits (even if they are unsuccessful, like in the above example) will lead to overly-careful doctors.
A final note is that patients tend to value their autonomy. Even in the U.S. where there is sometimes a culture of authority surrounding physicians, there are plenty of patients who want to make their own informed decisions surrounding their healthcare. In this question’s example, the physician recommended to the patient that he should stay overnight for observation. Assuming that the doctor explained the reasons the patient was at high risk for stroke, and the risks of going home without a hospital stay, the patient exercised his autonomy in choosing to go home. It is unfortunate that the patient somehow thought the doctor should have “forced” him to stay against his wishes. The physician did his best to act beneficently, the patient exercised his autonomy in his decision-making, and unfortunately, those two ethical principles weren’t enough to save this doctor-patient relationship.
-Rebecca Fink
In this particular case, I would have to agree with some of the points that Jessica made. A doctor can only do so much for his patients. If he has taken all necessary steps or precautions to ensure the patient's best outcome, the doctor should not have to face the malpractice case. For many cases, the courts will look to see if the defendant has breached any of their expected duties. In this case, I feel the doctor had done all he could. The fees and time spent out of work seemed excessive for the situation. A good friend of my family has his MD and law degree. He has said many people will file these malpractice cases simply out of their desire to become richer. These are the situations in which the courts should recognize that the doctor has acted in good faith and should not be held liable.
ReplyDeleteHowever, there are situations in which patients can utilitze malpractice cases such as with complications that could have been avoided during surgery or with incorrectly prescribed medications. If the issue is severe, such as a significantly wrong diagnosis or perhaps extreme complications that arise from careless errors in surgery, filing suit would be the correct path to take. Essentially, each situation must be looked at to determine if compensation should be paid to the patient or if the doctor put his full effort to care for the patient.
-Kaitlyn Mardeusz
I think Kaitlyn brings up an interesting point at the end of her post when she distinguishes between a doctor who is convicted of malpractice and a doctor who gave "his full effort to care for the patient."
ReplyDeleteCertainly, if a doctor does not put fourth his or her best efforts to act beneficently when treating a patient, then he or she should be held accountable to a malpractice suit if there are negative consequences that result. However, if a doctor does put his or her best effort towards caring for the patient and something still goes wrong that results in negative consequences, is it justifiable for that doctor to still be sued for malpractice? What role should intent play in making decisions about how we hold doctors accountable for the negative consequences that result from treatments?
It doesn't really seem fair that a doctor who acts beneficently and treats a patient to the best of his or her ability should be sued or punished if there is a negative consequence (such as the example from the prompt) that was not directly in his or her control. But then how do we distinguish between doctors with good intent and those with bad intent? This doesn't seem to be an easily measurable quality, so how can we determine whether or not a doctor should be guilty of malpractice based on their intent and effort to care for the patient? I don't think we can. I would hope that it is an expectation in our medical system that doctors intend to do well and act in the best interest of their patients. I understand, unfortunately, this is not always the case, but I don't think it would be feasible or useful to determine a physician's culpability in a malpractice situation based on just his or her intent.
Malpractice is when improper, illegal or negligent treatment is administered to a patient according to professional standards of medical care. Whether the physician meant to provide a treatment that would be considered improper, illegal or negligent or not doesn't seem to matter as much as the fact that they treated a patient incorrectly, and negative consequences resulted. A physician who makes a medical mistake that results in negative consequences should be held accountable, and according to how malpractice is defined and practiced in our legal system, if the physician caused harm because of a mistake, it shouldn't really matter that the physician didn't intend to cause harm.
Normatively speaking, intent should matter, but realistically, how can we measure intent or hold physicians accountable for effort? The only solution that seems reasonable is to look at the results produced. Perhaps evaluating the consequences, whether good or bad, can give us better insight into the quality of care that the doctor provided, rather than using intent as an ambiguous measuring stick for determining guilt or innocence in a malpractice situation.
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I agree with both Kaitlyn and Jessica. Although the doctor patient relationship is traditionally defined as more of a one-sided interaction, there are clear duties that the patient has toward the caregiver as well. In the case given in the prompt, it seems almost clear that the patient simply wants money from the "malpractice" rather than justice. It is clear the patient did not suffer severely from the incident and the doctor warned the patient that s/he should stay in the hospital.
ReplyDeleteAutonomy is clearly important in the situation and the right to autonomy is also a responsibility of autonomy. The doctor clearly gave the patient warning for the risks of leaving the hospital, and it was the patient's own decision to leave. Thus, the responsibility of the problem should lie on the patient's shoulders and not the doctors. It is important to recognize that the doctor is not subservient to his or her patients and that s/he cannot practice paternalism at the expense of the patient's autonomy. That would be ridiculous. As Kaitlyn stated, "these are situations in which the courts should recognize that the doctor has acted in good faith and should not be held liable."
If the relationship between the doctor and the patient had not been breached, it would be much easier to avoid medical costs for tests that perform as security against malpractice lawsuits. Overall, building towards a future where these costs are not incurred should be a priority. To do so, it may be important to recognize and perhaps punish individuals who simply sue doctors for money rather than justice.
As Tully mentioned autonomy becomes a vital issue in a case like this.
ReplyDeleteThe doctor recommended that the patient stay for observation and the doctor was looking out for the patient’s well-being while still respecting the autonomy of the set individual.
The patient choose to disregard the doctor’s orders and left on his own accord. Later when he came back (despite rejecting the doctor’s request), he was given the necessary treatment and no long-term damage was found to be caused.
The patient was fully conscious and rational enough to make his own decision. It does not seem fair to make a fully aware person listen to a doctor if they not want to, particularly if they are the ones paying for the medical care. It is unreasonable to ask the doctor to somehow force the patient to listen to him; all the doctor can do is give his suggestion and let the patient decide if he wants the doctor’s recommendation. The patient needs to understand that they have a right to exercise autonomy but need to take responsibility for the acts they decide to do as individuals. The doctor can only suggest an action; the rest is up to the patient.
At the same time if the doctor managed to somehow force the patient to stay and a stroke did not occur, then the patient wastes time, energy, and hospital bills for medicine he did not have autonomous control of, and he can easily blame the doctor.
If the patient decides to consider the doctor’s’ advice and come to his own conclusion, then it is his responsibility to live with the decision that he has come up with. Instead of blaming the doctor, the patient should have realized that someone with medical expertise probably suggested staying in the hospital overnight for a reason, and if the patient doesn’t understand this concept, then there is very little a doctor can “forcibly” do.
The Hippocratic Oath means a doctor should help an individual, but the individual needs to allow the doctor to make certain decisions. If they stay in the care of the doctor, the doctor should provide proper aid. But if they leave the medical care, despite a doctor’s desire to continue it, there is not much they can do.
There also exists in our society a Samaritan Law which means that if you try to exercise beneficence and something bad happens in the process it is acceptable if you tried to commit good. If this is our standard for individuals, then I don’t see why doctors simply because of their profession should be held to such high standards.–Gellena Lukats
As Tully mentioned autonomy becomes a vital issue in a case like this.
ReplyDeleteThe doctor recommended that the patient stay for observation and the doctor was looking out for the patient’s well-being while still respecting the autonomy of the set individual.
The patient choose to disregard the doctor’s orders and left on his own accord. Later when he came back (despite rejecting the doctor’s request), he was given the necessary treatment and no long-term damage was found to be caused.
The patient was fully conscious and rational enough to make his own decision. It does not seem fair to make a fully aware person listen to a doctor if they not want to, particularly if they are the ones paying for the medical care. It is unreasonable to ask the doctor to somehow force the patient to listen to him; all the doctor can do is give his suggestion and let the patient decide if he wants the doctor’s recommendation. The patient needs to understand that they have a right to exercise autonomy but need to take responsibility for the acts they decide to do as individuals. The doctor can only suggest an action; the rest is up to the patient.
At the same time if the doctor managed to somehow force the patient to stay and a stroke did not occur, then the patient wastes time, energy, and hospital bills for medicine he did not have autonomous control of, and he can easily blame the doctor.
If the patient decides to consider the doctor’s’ advice and come to his own conclusion, then it is his responsibility to live with the decision that he has come up with. Instead of blaming the doctor, the patient should have realized that someone with medical expertise probably suggested staying in the hospital overnight for a reason, and if the patient doesn’t understand this concept, then there is very little a doctor can “forcibly” do.
The Hippocratic Oath means a doctor should help an individual, but the individual needs to allow the doctor to make certain decisions. If they stay in the care of the doctor, the doctor should provide proper aid. But if they leave the medical care, despite a doctor’s desire to continue it, there is not much they can do.
There also exists in our society a Samaritan Law which means that if you try to exercise beneficence and something bad happens in the process it is acceptable if you tried to commit good. If this is our standard for individuals, then I don’t see why doctors simply because of their profession should be held to such high standards.–Gellena Lukats
I agree with many of the above posts in that there should definitely be some restrictions within the legal system regarding the appropriateness of malpractice suits. However, I think that determining the parameters for such a specific set of laws would be difficult because the line between an acceptable malpractice suit and an unnecessary one is very fine. Of course there are obvious extremes in both cases, (the stroke incident from above vs. a doctor amputating the wrong limb) but there are also cases that aren't immediately clear. I think it would be fair to say that a malpractice suit is acceptable if the doctor did not act with beneficence, withheld information from a patient and/or acted with negligence.
ReplyDeleteI do not think that doctors should fear malpractice suits so long as they do everything in their power to act beneficently and consider what is best for each patient. In the above case, the doctor recommended that his patient remain in the hospital overnight and the patient refused, as is every patient's right. Forcing the patient to stay overnight would be limiting the patient's autonomy. I know I value the right to make my own decisions about my own health, and if I had been forced to spend a night in the hospital (incurring an even larger medical bill) I'd probably be fairly unhappy about it. Therefore, it was ridiculous of the patient to suggest that his doctor should have forced him to stay in the hospital.
I think the main culprit in this dilemma is rising medical costs. The costs of expensive procedures and hospital stays paired with high insurance premiums (or a complete lack of insurance) creates a stressful situation in which people find themselves spending an inordinate amount of money on healthcare, and in some cases seeking inappropriate methods to pay for it.
It is not uncommon to see the prevalence of malpractice suits against doctors but after reading this article and realizing what this patient was capable of doing, it seems to me that people tend to forget that doctors are not perfect and magical healers that, so-to-speak, by raising their magic wands, can prevent and simply take away an existing disease or health issue of any sort. It raises the question of perhaps what makes patients do what they do against doctors. Perhaps it is the sight of seeing a large medical bill in the mail that leads to a type of anxiety and panic - and the only solution is to put the person in charge who supposedly makes all the decisions. Yes, I believe that it is true that people look up to doctors because of what they do as a job, however patients should also realize that they should not always blame doctors for their decisions. They tend to forget that the doctor did not make a decision on his/her own, because that patient's participation was also required. It is a two-way street, not one, and when something goes wrong, patients tend to forget that it was them too, who helped come to terms with the doctor in making the decision together, and when one seems to so easily forget, then this is what leads to crazy suits.
ReplyDeleteI definitely believe that there should be restrictions within the legal systems about appropriate malpractice suits. If one suit was reviewed and thrown away because it was frivolous, then it should not be reviewed again. In addition, if a case, such as the one mentioned in the article, occurs, there should be a contract that is signed by the patient and the doctor stating that they have discussed the terms and if a patient ignores a doctor's recommendation, then I believe this will decrease and hinder the amount of malpractice suits that come into court. By doing this, this shows that even after a patient is told about what a doctor recommends, and refuses the doctor's recommendations, their signature shows that they are aware of consequences and possible outcomes. I believe that even though it's hard to just tell a doctor to just not worry about future and/or current malpractices, I truly believe that they should not. The act of performing what they were trained to do as a job in fear will make the doctor look weak because they will make and base their decisions due to a lack of confidence and worry about the outcome of their decisions. They are supposed to help cure and relieve a patient's pain and if they are scared of being sued, then what good is it in even bothering to tending to a patient??
Just a note- the Good Samaritan laws protect only those that are acting without any type of medical license (medical license = EMT,RN,MD). It is expected that if medical personnel take any kind of action, they should know what they are doing. Even if a medical person is off-duty, Good Samaritan laws may not apply.
ReplyDeleteThe thing that bothers me in this example is there is no negligence. Negligence is defined as a case where there is a duty to act, there is a breach of duty, and that breech causes harm. In this case there is simply no breech of duty. A doctor cannot force a patient to stay in a hospital if that patient is fully alert (which can be determined fairly easily and accurately).
I believe that malpractice suits should only be considered if a clear case of negligence is present. I'm saying this curtly to save time, but patients need to get over the idea that they themselves as individuals are special. By this, I mean there is nothing special that protects any given patient from the possible complications of medical conditions or actions. A negative outcome does not mean a doctor did anything wrong. By this principle, I believe that there should be laws that define appropriate cases of malpractice. Additionally, I believe there should be a set amount of money awarded depending on the type of injury- money that compensates for medical bills and time lost. This system would streamline malpractice suits by cutting down on legal fees and time spent deliberating in court. Doctors would be able to be more confident in their actions, and would therefore be better suited to act beneficently.
~Matthew H
I think the point Rebecca brought up about acting “too beneficently” is an extremely interesting one. In the above example, the doctor suggested that the patient stay the night in the hospital for observation. It seems as if, in this situation, the doctor was looking to protect the patient. He wanted to make sure the patient was safe due to the high probability of stroke. What if, however, the doctor was, in fact, just practicing defensive medicine? The doctor could have been trying to limit the amount of malpractice he could foresee by taking excessive precaution to ensure the patient would not blame the probable stroke on him. . Since the US does not have a centralized system (like the NHS in the UK) to ration unneeded procedures, unnecessary procedures are often preformed for the sole purpose of making sure the doctor will not get sued at a later date. It has already been stated multiple times in entries above that the patient valued autonomy and therefore did not take the advice of the doctor, but no one has mentioned the fact that the patient could have seen the doctors intentions as something other than beneficent and felt the need to act distrustful in response to it.
ReplyDeleteRegarding restrictions on what is considered a malpractice suit and what is not, I agree with Jessica when she says that there should be restrictions on what is considered malpractice. Specifically in this case, the doctor should not be held accountable after giving all appropriate advice and having the patient say, “no, thank you” to the suggestion of a night in the hospital.
-Caren Steinway
I read this post over a few times and I came to a one conclusion. People are always going to be money hungry and with the added stress of excess medical bills and accrued debts individuals often loose all sense of logic, transforming into ignorant and ruthless beings. Like most goods a consumer can purchase, healthcare is expensive. When the patient declined the doctors suggestion to stay overnight at the hospital (most likely to avoid additional expenses) and returned the following day in worse shape only to accumulate greater costs for care it is similar to a consumer who purchases a new laptop and refuses the advice of the salesman to tack on the extra 100 bucks for product protection, only to return the next day with a broken screen and no choice but to spend more money and have it fixed. In such a situation a consumer could not sue the salesman for not forcing him to buy the warranty so why would someone believe it was O.K. to go after the doctor whom they did not listen to? The bottom line is this...no matter what job or career one enters, if you are dealing with the general public it is essential to cover your actions from every angle with documented proof of reasoning and hard evidence. This case would explain why doctors make their patients sign a form before exiting the hospital against medical advice and salesmen make their costumers sign receipts stating they were informed of additional warranties and either opted to purchase or not purchase such options. In the above case had the doctor stated the patient should stay overnight for additional tests and the person signed themselves out of the facility against such advice, I am unaware of how a lawsuit could even be established and considered valid? Also, I was under the impression that the court system implemented certain regulations regarding lawsuits to prevent people from filing unwarranted claims for example "if one chooses to bring allegations against another party and looses during a court ruling, they would be responsible for all lawyer fees and court costs associated with the case including those belonging to the opposing side". If such regulations are not already in place I think it would be a good idea since this would stop people without a solid case from trying to seek large payouts from innocent doctors. Additionally, in cases such as the one mentioned above, it would have eliminated the doctors responsibility to pay for his defense attorney and increased malpractice insurance.
ReplyDeleteMalpractice lawsuits create a huge problem in a world with already high health care costs by creating a medical practice in which physicians are scared of lawsuits, resulting in orders for unnecessary procedures and tests just to cover a physician from being sued. Not only do these tests create high costs for patients who may not know any better, they take away resources and the physicians time from other patients who actually need treatment. It is obvious from these increasing health care costs caused by defensive medical practice that some type of limit or restriction needs to be placed on filing malpractice suits.
ReplyDeleteThe doctor in the situation presented in the original prompt was not trying to inflict harm upon the patient, but the exact opposite. The doctor wanted the patient to stay another night in the hospital. Whether this suggestion was given to cover himself as a physician or to benefit the patient is unknown. In my opinion, when the patient decided to act on his autonomy by declining the physicians suggestions then they should accept all consequences that come from such a decision. Would the patient have suffered a stroke if he had stayed in the hospital another night? This question cannot be answered however, the doctors would have been able to care for the patient much faster and monitor the situation more carefully. The patient did not give the doctor this opportunity to do his job, so it is ridiculous that the patient then wanted to blame the doctor for the consequences that ensued.
It would have been a completely different story if the doctor was trying to inflict harm onto the patient. Such harm could include anything from withholding knowledge from the patient to ordering a test the physician knew would harm the patient. An extra night in the hospital may have cost the patient extra money(in medical bills that he ended up paying anyways) if they were not insured, but it is not the doctors job to base treatment advice on whether or not the patient will be able to pay for it. If this were the case, doctors ability to do their job in a quality manner would be completely undermined. Doctors should give their knowledge of which options would be best so that the patient can at least have the opportunity to find a way to pay for it if they want to go through with such a procedure/treatment.
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-Kristen Brady
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ReplyDeleteThis leads me to a point that has been discussed previously that I also agree with, the fact that medical malpractice lawsuits should be limited in the sense that what is considered malpractice should be restricted. A doctor who is intending to do harm (ie. recommending a procedure that is widely known in the medical world to cause a certain harm, or recommending procedures that the physician will benefit from finanically, as a stakeholder) should be considered malpractice. A doctor who does everything in his knowledge to help the patient only to not have his advice followed should not be held responsible for the patient acting on their autonomy.
The patient in this situation clearly could have avoided this whole situation by remaining in the hospital and following the doctors advice. It is clear that after returning to the hospital while mid-stroke the patient was quickly treated and sent home with no long term damage and a medical bill. If he stayed in the hospital he would have probably had a smaller bill(no ambulance) and the stroke could have been treated even sooner/avoided. The patient really caused harm to himself in avoiding the physicians advice.
In conclusions, the restriction on medical malpractice lawsuits need to define what is considered malpractice so that patients cannot try and get money out of physicians every time something goes wrong even after they ignore the physicians advice. Also so Doctors have a clear understanding of which actions will result in a suit and do not feel the need to cover themselves with unnecessary procedures. This will result in a strong foundation of trust in the doctor-patient relationship in which both sides are focused on the task at hand - treating the patient and providing/receiving the best care possible for the given medical situation. There will still be malpractice suits(as we cannot completely rid the system of these, doctors need to have some type of check on their performance and actions and be held responsible when they do harm) but we will avoid unwarranted suits againts doctors that are motivated by greed for money and not negligence on the doctors part. The last thing we need in the current economy is another factor that gives the doctors incentives to increase the number of unnecessary procedures that drive up health care costs for the average person, and even worse the uninsured.
-Kristen Brady
It was clear from the very beginning of this article that the patient was only taking his case to court to receive enough compensation to pay his medical bills. It doesn’t take 4 years of schooling and the title of J.D. to know that most malpractice cases are actually filed out of greed and hunger. I don’t believe that we will ever be able to stop human nature. The government can get involved all they like, they can pass bills on top of bills protecting doctors from these malpractice suits, but in the end human nature will prevail. These bills won’t stop people from putting themselves first. There is no clear definition of an appropriate malpractice suit. It’s up to the judge to decide and to know when a case is irrelevant and out of greed such as the example stated on this blog.
ReplyDeleteThis argument can go on and on, but there is only one clear-cut answer to this issue. The U.S. health care system needs to change. These malpractice suits and thousands of dollars spent fighting them are the result of a greedy country. The hundreds and thousands of dollars in medical bills have driven individuals to this point. They attack the first source they find to be the culprit, the culprit always being the doctor. It’s not the doctor who should take the blame, however. The country needs a health care reformation, one that can make its residents healthy without putting them out on the street.
There absolutely needs to be restrictions on the use of malpractice suits. In an already overpriced system, malpractice suits only add to costs for both the patients and the doctors. The doctor in this case acted appropriately when he advised the patient to stay in the hospital for observation but did not force him to do so. The patient had the right to leave on his own, even if it was against medical advice. Though the case was thrown it, there were costs to both parties. The man suing the doctor now had lawyer fees on top of his medical bills, and the doctor had legal fees and had to miss a week of work. If the doctor had forced the patient to stay, the patient would not have been allowed to act autonomously. If the man had stayed and had not had a stroke while in the hospital, he still would have been charged for the extra day and might have still sued. It is obvious in this case that the suit was filed only for the money as the patient suffered no significant damages. Placing limits on malpractice suits will not be an easy task because each case is specific, but something needs to be done in order to lower costs for all parties involved. Doctors should have to provide justification beyond not wanting to be sued for ordering expensive tests and procedures. There are many things wrong in our health care system, but the non- restrictive malpractice suit regulations do not help to bring down costs. A suit can also ruin the reputation of a very good doctor, even if the case is thrown out. There needs to be a more clear cut way to define what is worthy of a malpractice suit.
ReplyDeleteThe way this case is presented, it seems like a foregone conclusion that the patient is wrong and the doctor is right. Clearly, the case the patient has brought against the doctor is frivolous as the doctor did recommend that the patient remain in the hospital and thus the patient's ordeal was due to the patient's rather than the doctor's negligence. In a legal sense, the case should be thrown out.
ReplyDeleteIn a greater ethical sense though, taking away the right of the patient to sue or seriously curtailing that right could lead to more patient deaths, which would most probably ethically outweigh the potential headaches of legal costs that every doctor currently has to handle. For example, this particular family doctor will probably always be careful to insist that a patient stay overnight if the doctor believes the patient may be at risk for any major complications. Although this may raise the costs of health coverage significantly over time, it is also true that defensive medicine will also save some lives over time that would not have been saved otherwise. It is estimated that over 100,000 patients die per year in the United States due to medical errors. This number would certainly be higher if medical malpractice suits were abolished. One only needs to look at countries like India where doctors can treat patients as research subjects without their consent.
Clearly, medical malpractice reform is necessary in the American medical system, but one must also look at the other side of the equation and then create a workable balance.
The deplorably lenient Statutes of Limitations on medical malpractice lawsuits are one of the most significant reasons for the decline of health care in the United States. Frivolous suits are filed every hour and as a result, doctors feel obligated to test and treat patients far too aggressively. It has become the norm in modern American healthcare to use blunt force testing to reach a diagnosis; that is, to subject patients to dozens of scans, tests and analyses in order to find something that isn’t within normal limits and point to it as the cause of symptoms. The result is a system whose costs skyrocket as fast as its quality of care plummets.
ReplyDeleteDoctors feel safer using this method because, while not foolproof, it greatly increases the chances of an accurate diagnosis and leaves less room for error or negligence. But this comes at the literal expense of the patient and, if they have Medicare, the taxpayers supporting their coverage. This technique, while often effective at determining the cause of a patient’s symptoms, is incredibly inefficient and detrimental to the progression of the health care community as a whole. When a patient comes into a private hospital’s Emergency Room with joint pain and a cough, and the residents there immediately send him for a full-body CT scan, the system is incurring a high and unnecessary cost. It should also be noted that all of this is done without consulting the patient. They may consent to the tests, but a patient scared of his/her unknown illness is often not in a position to question the judgment of a licensed physician. As a result, the patient’s wishes regarding aggressiveness of treatment are ignored.
The alternative to brute force is finesse. It is to use traditional diagnostic methods to reason through a patient’s symptoms and relevant medical history to find the cause(s) of symptoms. There is inherently more room for error using this system because the human mind is less reliable than a laboratory test. However, we should recognize that with more laboratory tests come more false positives, and thus more unnecessary and expensive treatments. The problem with asking docs to use this method of diagnostic reasoning is their collective fear of malpractice suits. The cost, from a physician’s perspective, of additional testing is well worth avoiding the astronomical costs of hiring a lawyer, losing time at work, and the stress incurred by both.
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ReplyDeleteTesting is not the only source of over-treatment, however. Grossly overpriced brand-name prescriptions are given to patients (for because the pharmaceutical company developing the drug still has a few years left on its contract to claim ownership. Yes, this system provides an incentive for the pharmaceutical titans to aggressively pursue new drug therapies, but the lack of regulation of contract terms results in their having free reign over drug pricing.
The solution to be adopted is to strictly regulate what can be classified as a legitimate malpractice lawsuit. For example, Pennsylvania has a very progressive and helpful statute of limitations on suits. Since 2002, the window for filing a claim has been reduced to seven years after from the date of the treatment, and two years for a death case. It also adopts a policy of contributory negligence, which reduces the plaintiff’s recovery amounts based on how much of the injury/outcome is deemed to be his responsibility, and a strict guideline for what qualifies a physician as an expert witness. More laws can be instituted to aid in this endeavor, such as strict double jeopardy regulations (where were they in the case prompted in the beginning of this post?). In the end, I believe that a universal revision of malpractice law, especially regarding the statutes of limitations, is desperately needed.
-Chris Wagner
Medical Malpractice lawsuits have reached a ridiculous degree in today’s society. Too many people see it as a get rich scheme and not as a method to compensate those who truly suffer from medical error. The idea that doctor’s are concerned whether they will face a lawsuit while treating the patient, having done nothing wrong is a shame. Doctor’s should only have to worry about lawsuits when they make a mistake or an error that results in negative consequences for the patient. Doctor’s understand that they are only human, and no matter how much knowledge or how much experience they might have, errors are inevitable and unavoidable. Everyone makes a mistake, and doctor’s understand that and cover themselves by using medical malpractice insurance. The problem lies when people see it as an easy way to money which is only encouraged by the numerous law firms that advertise in hopes of attracting clients for big payouts. This relatively new fear of lawsuits has resulted in an increase in costs for a hospital visit since doctor’s feel that they are only covered if every possible test is performed. This results in longer waiting times in emergency rooms since patients undergo numerous tests that a few years ago would otherwise not have been performed. Doctor’s are also admitting record high number of patients to the hospital, resulting in limited beds, and fewer nurses per patient, all of which result in lower quality of care. This trend of malpractice lawsuit avoidance care will only continue to worsen as the numbers of lawsuits continue to increase. The judicial system should begin to look deeper into each case and reassess the monetary values awarded. In the end, I put the patients at fault for this entire situation. Patients put doctors “on a pedestal” and expect perfection. They must realize that doctors are there to help and not harm, and that their intentions are always in the best interest of the patient.
ReplyDelete-KEENAN
I think that to understand anything begins with knowing that there are exceptions to everything. I don't believe there can be a solid and unchangeable definition to malpractice because the definition reinvents itself case by case, and as always, culture by culture. I don't think something can be deemed malpractice just because something else went wrong, I think a stronger focus on the end product is more significant. The end product in this case was a relatively healthy man struggling from medical bills. The stroke caused him to change his lifestyle and most likely better respect his body and health. If this is the only part of the case that is examined, it would most certainly not be considered malpractice. Though the entire reason for the man not staying overnight in the hospital is unknown, I think it can be assumed that medical expenses were partially the cause. It has long been known that the patient is not always the best judge for himself or herself because the patient does not always have his or her best interest in mind. The aforementioned man with the stroke is a clear example of someone trying to save himself and his family some money instead of staying in a hospital where something bad may or may not occur.
ReplyDeleteThe objective of hippocratic utility is that the physician should benefit the patient and protect the patient from harm as the benefits and harms are determined by standards that are objective rather than based on the physician’s personal judgments. Using this, a doctor should be able to remove himself of personal bias in a situation and make a clear decision for the patient's benefit. In doing so, the doctor is naturally practicing beneficence, for he is only thinking of doing good for the patient. The doctor, here, suggested the patient stay overnight but the patient declined. The doctor must respect both the patient's best interests, health-wise, but also the patient's autonomy, in that after being informed of the reasoning behind staying in the hospital, the patient still declined.
Doctors have a moral obligation to practice beneficence and I think malpractice laws should be much better defined and enforced so as to eliminate any fears doctors may develop of doing the greatest good for the greatest amount of people.
I think Matthew brought up a great point in mentioning negligence. I too agree that lawsuits should be pursued only if the plaintiff can prove either negligence or maleficence. That being said, negligence can often be the result of overworked doctors and unreasonable expectations. For example, most medical residents work 24-48 hour shifts at a time and are expected to treat patients with the utmost quality. Is this a plausible expectation? In an article published in the British Medical Journal several years ago, researches suggested that people who stay awake for 17-19 hours show some of the same effects as if they were intoxicated. Many studies have shown similar results therefore proving that a sleep deprived doctor is likely to perform below his or her standard. This begs the question, is it ethical to expect physicians to function on such a schedule? Sure we can sue them for negligence, but who is really responsible? At some point we must reflect on the root of the problem and determine whether it is the physician who is at fault or the unhealthy conditions they are encouraged to work in. I believe some measure must be put in place to monitor these hours and make sure that health providers are being protected, both from health hazards and legal attacks.
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