Defensive Medicine: Tort Reform Does Not Address Concerns

Defensive medicine implies added or unnecessary services including: extra screening tests, needless hospitalizations, prescriptions, and procedures; all in the pursuit to reduce bad outcomes and decrease the chance of malpractice lawsuits. Defensive medicine is frequently reported as being a costly and unnecessary and could be reduced by lowering the amount of frivolous lawsuits. It's also regarded as one of many causes behind increasing health expenses, however its use is common. One study completed in 2009 by Jackson Medical Care, found that defensive medicine of some form was practiced by 92% of physicians questioned. A Gallop poll in 2009 found that 78% of doctors interviewed practiced defensively. The cost of defensive medicine is calculated at $650-850 billion dollars annually.

Tort reform was supposed to help reduce lawsuits and lower healthcare costs. Many states passed legislation to increase the standards for malpractice in emergency medical care, however, a recent study within the New England Journal of Medicine found that this had little impact on imaging rates, hospital admission rates, and average expenses. Physicians continue to view their risk of litigation as large and that practicing defensively will help reduce this danger. The truth that many malpractice claims are dismissed did not matter. Fiscal costs and the personal toll of malpractice lawsuits are extremely real – the average doctor spends almost 11% of a 40-year career with open and unresolved malpractice claims according to one study.

One suggestion to help restrict unsupported legal claims incorporates “safe harbors” to utilizing evidence-based guidelines in practice. These guidelines will be hard to establish with many contradictory recommendations around. Development of practice guidelines for safe harbor protection will soon be extremely challenging, but has the potential to benefit both patients and providers, which has not been the case with existing tort reform efforts.

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Failure to Vaccinate!

The recent outbreak of measles has spread to eight states and infected almost 100 individuals. Measles is an airborne virus that infects almost 90% of those which are unvaccinated if they are exposed. Many vaccine preventable diseases have dwindled through the years so parents have less understanding of the devastating results of these illnesses and, as a result, are more inclined to concentrate on potential adverse effects of vaccination. Unfortunately, deceitful studies, celebrity opinion, and anecdotal evidence, frequently repeated by the media, have gotten lots of people to jump on the "anti-vaccination" bandwagon. Children can receive an exemption for religious or philosophical beliefs, or medical exemptions although vaccinations are supposed to be required to enter school in the USA. Forty states now permit philosophical exemptions and those states have a higher vaccine exemption rate than states that simply allow religious exemptions. They also have a higher rate of the illness.
In 1998, the measles-mumps-rubella vaccine (MMR) came under fire after a small study supposedly illustrated damage to the intestinal lining causing autism. This study was retracted in 2010 and attested to be fallacious in 2011. But, the media reports and hearsay continue to feed this inaccuracy. The risk of an adverse event associated with a vaccination is slight. The danger of acquiring measles for an unvaccinated person during an outbreak is nearly 35 times that of a vaccinated person. The disease is preventable by vaccination.

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Truth vs. Believability of Expert Witnesses

The truth should always be the main factor in the outcome of a legal case. In reality, we as individuals, frequently make decisions based on who seems believable, honest, or motivated. Jurors base their decisions more on courtroom drama and who appeared believable or most genuine, than on scientific facts and figures and often do not understand the facts. Thus, when choosing an expert witness, factors such likability and trustworthiness, confident body language, and speaking with authority are just as, or more, significant than real expertise. Witnesses who will speak with warmth and make an attempt to spell out the facts in a way a layperson can comprehend are crucial in winning a case. Expertise and credentials are required to allow the expert witness to testify, but play merely a minor role in persuading juries. Some believe that the current legal system in which each side pays and gets expert witnesses, enables the facts to become unimportant in the decision making process. Some have even suggested that so as to rebuild the value of facts, expert witnesses have to be appointed by the court to simply present and clarify the facts.

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The Danger of Unregulated Medications from Overseas Pharmacies

The high expense of drugs in the US has motivated some professionals, and patients, to seek more affordable foreign supplies. This might appear helpful to patients who are unable to pay for their medicines; yet, the FDA does not control drugs from abroad. Doctors and patients cannot be sure these drugs meet FDA standards for security, purity, and potency. A few of these drugs are counterfeit, putting patients in great medical danger and putting physicians in danger of malpractice.

Doctors who buy drugs to dispense should check the wholesaler's license, and check that the drug maker approves the distributor as an accredited wholesale distributor. When a patient is buying drugs online or abroad, the doctor should educate and help those patients investigate alternatives including patient support systems and generic drugs.

Unapproved drugs sometimes don't include the active ingredients; could be contaminated with alternative substances, or heavy metals; they also may have been improperly stored. There aren't any promises for Americans who are searching for prescription drug bargains. Even 'Canadian online pharmacies' are frequently only shipping companies for drugs obtained throughout the world and aren't controlled regulated.  The only safe policy is strict adherence to all legal guidelines in place to protect American consumers.

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Can a Doctor Be Held Liable for a Patient's Unhealthy Conduct?

Family, friends, and caregivers frequently give priceless advice to a physician that can significantly help in diagnosis. How does this information affect possible lawsuits down the road? For example, what if the doctor doesn't use this advice? Can a doctor use this information in the defense of a liability claim and can a jury use it in their deliberations? 

In one case in 2014, a doctor wasn't held liable because the physician was told by buddies of the patient several weeks after the incident, that cocaine was often used by the patient. The physician had been sued for liability because the doctor had made no attempt to recognize the cause of a cyst before draining it. During that procedure the patient went into cardiac arrest. The outcome was in favor of the physician as the jury determined that the cardiac arrest was caused by the patient's unhealthy behavior. Another case in Florida allowed that the physician might still have some liability even in the event the patient's unhealthy behavior contributed to the outcome. Even in the event the patient's behavior was likewise contributory, it is possible that the doctor is also partially negligent.

The best advice is for physicians to check health information provided by family and friends. This advice also has to be documented completely in the patient's chart as well as the attempts made to check the info. If the physician faces a challenge in court, this documented and verified advice will likely be accepted as a legal defense against liability.

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Too Much Paperwork?

Patients vs. Paperwork: Are the Many New Regulations Being Put on Doctors Detrimental to Medicine?

For starters, Medicaid compensation will be rolled back to 2012 levels, a cut of around 40%. For doctors who see lots of Medicaid patients, this may be a significant decline in their income. The other whammy that physicians face is payment reductions due to quality control measures and Medicare cost-cutting that are kicking in this year- measures that could cut Medicare compensation by 13%. These three measures are Meaningful Use regulations, the Value-Based Modifier Program, and the Physician Quality Reporting System.
The Centers for Medicare & Medicaid Services (CMS) announced recently that 257,000 healthcare providers (about 50%) had been discovered to be in breach of the "meaningful use" requirement and would have their reimbursement cut by 1%. Physician resistance to participating in CMS's quality control programs might be more about anxiety about change- and also about fear of not being able to satisfy the quality standards- than about an excessive amount of paperwork.
The American Medical Association (AMA) complains that this heavy burden of regulations is stifling investment in health IT and infrastructure, and is also changing patient care. The AMA says that health care providers are excessively busy attempting to figure out what the regulations mean and how exactly to meet them to focus on their real job, that of taking good care of patients.

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What Are the Chances of Dying From a Hospitalization? Infections Are Down Dramatically

While hospitals are places for treatment and healing, they’re also places where people can potentially acquire fatal infections or suffer from medical mistakes. But, there is good news! The chances of dying just because you go to the hospital are down dramatically, according to a new government report.

The analysis from the Department of Health and Human Services finds 1.3 million fewer instances of harm to hospital patients between 2010 and 2014 – a 17 percent decrease in that three-year period. That translates into an estimated 50,000 more patients being alive today.

The report says the precise causes for the decline in hospital-acquired conditions is not known. The report notes that time period studied in the report coincides with a span of time when there were greater hospital efforts to increase safety and cut down on adverse events.

These efforts are driven in part by changes to Medicare that incentivize hospitals to do better. Starting in the 2015 fiscal year, hospitals ranked in the bottom 25 percent for hospital-acquired infections will see their Medicare payments cut by 1 percent.

A preliminary government analysis released in April found that 761 hospitals would be subject to the penalty. But that total could be much higher when the list gets finalized. The government will be looking at hospital performance over a longer time period, Kaiser Health News reports. These hospital sanctions will cost an estimated $330 million over the course of a year.

Another area where hospitals improved in patient safety is cutting down on instances where patients are given the wrong drugs, which can lead to an allergic reaction or some other adverse event. The report found that certain hospitals reduced these drug mistakes by 40 percent.

This documentation of improved patient safety comes with a beneficial side effect – reduced health care costs. The federal report finds that cutting down on medical mistakes saved $12 billion in the three-year period of the study. Despite the progress, government officials acknowledge there’s still room for improvement.

“These data represent the significant progress in improving the quality of care that patients receive while spending our health care dollars more wisely,” HHS Secretary Sylvia Burwell says. “HHS will work with partners across the country to continue to build on this progress.”

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