On Monday, June 15, President Obama spoke to physicians assembled in Chicago for the annual AMA convention. His subject: health care reform. I listened to most of the speech on the radio and have read the reviews. What I heard and what I read seem divergent.
What I heard was a detailed, well-presented, thoughtful speech that addressed physicians as partners in solving the healthcare crisis. What I heard was a receptive audience and a surprising amount of applause. My colleagues in medicine may call me naïve, but what I was left with is the impression that our new President may just have what it takes to fix this mess.
What I read was the usual media fluff such as “mixed reviews by physicians,” “not everyone agrees,” or “opposition to the President’s plans.” I guess the media never has a real story unless they can create two sides, regardless of the amount of support for each side. For example:
- ABC World News (6/15, Stephanopoulos, Todd): “[Obama] pitched his healthcare reform package to mixed reviews,” and “physicians biggest concern…is economic”
- The CBS Evening News (6/15, Reid): “Obama found himself on the defensive”
- New York Times (6/16, Pear, Calmes): “the group was receptive but wary”
If the story were about “Motherhood and Apple Pie,” journalism seems to require a few paragraphs at the end saying, “But not everyone agrees. Joe Smith of Hackensack, New Jersey, says that he is allergic to apples, was abused by his mother, and will not support the notion.”
But I digress.
What did Obama have to say about malpractice reform? Here is the section of his speech in which he addressed the issue:
“Now, I recognize that it will be hard to make some of these changes if doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable. That’s a real issue. And while I’m not advocating caps on malpractice awards which I believe can be unfair to people who’ve been wrongfully harmed, I do think we need to explore a range of ideas about how to put patient safety first, let doctors focus on practicing medicine, and encourage broader use of evidence-based guidelines. That’s how we can scale back the excessive defensive medicine reinforcing our current system of more treatment rather than better care.”
The issue is complex, as one Obama proposal under consideration would allow doctors to defend themselves if they followed professional practice guidelines. Those guidelines, however, are significantly less reliable than we are led to believe, as reported here only last month.
There will undoubtedly be much infighting both behind the scenes and out in the open. In fact White House Office of Management and Budget Director Peter Orszag acknowledges that the AMA “has at least floated informally ideas about how the system could be tweaked or changed.” That said, I foresee little change in the present system for resolving medical malpractice issues, at least on a national level, during the next several years. Better access to preventive care and earlier diagnosis is likely to do more for both patients and physicians than malpractice reform.
My personal view is that professional liability issues are not a significant contributor to the overall cost of healthcare. “Defensive medicine” is less a result of pressure from attorneys and more a result of pressure from demanding patients. Not every injury is worthy of an MRI, CT scan or even an x-ray. But because patients trust technology more than they trust their doctors and have a “7-11 mentality,” (“I’ve gotta have it now!”), both physicians and patients are no longer willing to live by the longstanding maxim that “time heals all wounds.” While that maxim is obviously not always true, time remains much more an ally than an enemy when it comes to the body’s remarkable ability to heal.
Dr. Scott Haig writes in Time, June 4, that “keeping insured patients who ask for expensive medical tests and treatments from getting them is quite hard… Physicians know that the patient who does not get what he/she wants [but doesn’t need] will just go to another doctor.” To that end, Dr. Haig noted, “playing along… is more likely to help your career than giving an educated and honest appraisal.”
Hopefully, care will improve, access will be better and costs will decline. That is the “holy grail” of healthcare reform. But I don’t foresee malpractice attorneys, plaintiff or defense, having to look for work under the Obama administration.