Survey Says and Says and Says

Jeff Segal, MD, JD, FACS

I doubt that lately, few subjects have been studied, discussed or argued as much as the effects that frivolous lawsuits have on the nation’s healthcare system. This summer, three more studies looked at this problem from various vantage points.

First, Jackson Healthcare investigated whether physicians working under contract with the federal government practice less defensive medicine than their private sector peers. As a reminder, as if anyone really needed one, defensive medicine describes ordering medically unnecessary tests, treatments or consultations to avoid malpractice lawsuits. The results?

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Physician-Rating Websites are Biased in Picking Doctors, Exaggerating Consumer Opinions, Says Paper

School of Public Health at the University of Minnesota Paper: Physician-Rating Websites are Biased in Picking Doctors, Exaggerating Consumer Opinions, Says Paper to be Presented at INFORMS Healthcare Conference June 2011

For several years, Medical Justice has made the case that most doctor rating sites have several fundamental flaws; many lack statistically a significant sample size of patient ratings which impacts the quality of information available to consumers. Doctors see between 1,000 to 3,000 patients a year, depending on specialty. Yet, most doctors only have a handful of online ratings. A paper, “The Information Value of Online Physician Ratings”, being presented at a healthcare conference sponsored by the Institute for Operations Research and the Management Sciences (INFORMS®) supports this point.

“The Information Value of Online Physician Ratings” is co-authored by Ritu Agarwal, professor of information systems and director of the Center for Health Information and Decision Systems, Guodong “Gordon” Gao, assistant professor, and PhD candidate Brad Greenwood, of the University of Maryland’s Robert H. Smith School of Business, along with Jeffrey McCullough of the School of Public Health at the University of Minnesota.

The authors investigated potential biases among Internet users rating general practitioners on websites. In particular, the study looked at which doctors patients chose to rate, how they rated those doctors and the intensity of the patients’ opinions.

Agarwal states, that physicians are concerned whether “these ratings a true measure of clinical quality.” Or are they just the rantings of a disgruntled minority.

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Hey Doc, Can You Get Me Some Botox?

Michael J. Sacopulos, Esq.

Last week my wife was approached by a woman that does microderm treatments and other facial services. “Would you serve as my doctor for getting Botox? I can give the injections. I just need you to get the Botox for me. It will be fun!” exclaimed the woman. My wife, an optometrist, declined and tried to point out the dangers associated with injecting a neurotoxin into someones head. Undaunted, the woman stated, “No problem. Someone will get me the Botox. I have three treatments already scheduled for Friday.”

I fear that this was not a unique situation.

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Defensive Medicine and Disposable Helmets

Jeff Segal, MD, JD, FACS

A lot has been said and written about defensive medicine. Some pundits have stated, “If I’m a patient, I want you to practice defensive medicine.”

This is where the misunderstanding begins. There is universal agreement that doctors should do what is reasonable to keep patients safe. Period. Doctors agree. As do patients and attorneys.

But, defensive medicine is different. Defensive medicine has a different purpose. It includes tests, referrals, and procedures focused primarily on keeping doctors out of the courtroom.

Some will argue “Wait a minute. Shouldn’t a doctor do everything possible to prevent a problem?” Here’s where an analogy helps.

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Real Reform or Just Whack-a-Mole

Last week, the NC State Senate approved changes in the state’s medical malpractice laws; including provisions to give emergency room doctors more protection against lawsuits (changing their malpractice standard from ordinary negligence to gross negligence) and a cap non-economic damages for patients at $500,000 (economic damages and medical payments would not be capped). The proposal now moves to the State House for consideration.

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Supply and Demand, Healthcare Style

As we consider ways to improve health care and its costs in this country, perhaps we should be thinking of physicians as the valuable economic resource to society that they are. We clearly have an impending shortage of physicians to address the demographic tsunami – Baby Boomers entering Medicare age. And the lead time to train adequate capable physicians to address this trend is measured in years, not months. The fewer physicians available to take care of the public, the more expensive care will be. We should be doing all we can to make the practice of medicine inviting, so there are enough talented individuals to deliver care…. Makes sense, doesn’t it?

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Informed Spousal Consent: A Great Idea Worth Spreading

Jeff Segal, MD, JD, FACS I was thumbing through General Surgery News recently and read an article espousing a great idea; an idea worth spreading. Philip Schaurer, MD, and Jim Saxton, Esq. wrote about adding a spouse’s name to the informed consent document. Informed consent, of course, is a process, and not a document. But, … Read more

Your Mother Was Right

Michael J. Sacopulos, Esq. Doctors are busy, enough said. The problem is too many doctors are not getting enough sleep. According to a recent New England Journal of Medicine (NEJM) article “sleep deprivation adversely affects clinical performance and impairs psychomotor performance as severely as alcohol intoxication”. There are currently work/sleep regulations in place for first … Read more

Senate Fails to Pass First HCR Fix

On Monday, September 29, 2010, the U.S. Senate made two attempts to repeal a relatively minor but unpopular aspect of the Healthcare Reform laws. Though both Democrats and Republicans agreed that the aspect was an unwarranted burden on businesses, they could not agree on either of two bills devised to reform the reformation. The offending aspect, which requires that those who pay out more than $600 per year to any one entity must file a 1099 form, was intended to provide an increase in revenues by increasing compliance with an existing tax law which already requires the filing of a 1099 form under the same circumstances.

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Surgeon Sentenced to Jail Time (HIPAA = Need To Know)

In classified environments, information is only available on a need-to-know basis. If you have no official business pertaining to a file, then you don’t need to know. Healthcare professionals should consider HIPAA to be a similar environment.

Last year, Congress passed HITECH, which tightened restrictions on healthcare privacy and increased penalties for transgressions. Unauthorized access to patient records can lead to jail-time. A surgeon working as a researcher at UCLA was sentenced to jail under the HIPAA. What happened? Here’s the rest of the story:

Huping Zhou, a cardiothoracic surgeon, was working at the UCLA School of Medicine as a researcher. His employment was terminated, but UCLA’s IT department didn’t block his access to electronic medical records at the same moment; it took the university some time to process retraction of the doctor’s authorization to the database. In that interrum, Dr. Zhou accessed and read his immediate supervisor’s medical records, as well as those of former co-workers. Then, over the next few weeks, his curiosity led him to remotely access of other medical records he was unauthorized to see, including those of celebrity patients.

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