From: hrubin@pop.stat.purdue.edu (Herman Rubin)
Newsgroups: sci.med
Subject: Re: Questions for MDs
Date: 23 Jul 92 18:53:51 GMT
Organization: Purdue University Statistics Department

In article <15744@pitt.UUCP> geb@dsl.pitt.edu (gordon e. banks) writes:
>In article <BrKFyz.6FB@wpg.com> russ@wpg.com (Russell Lawrence) writes:

>>Generally speaking, it seems to me we could rate the legal and
>>medical professions (ethics-wise) by comparing the way their 
>>respective licensing authorities handle complaints.  Would you 
>>care to compare the Pennsylvania medical board with the 
>>Pennsylvania bar association?  Which of them is more inclined to 
>>turn a deaf-ear to complaints from the public?  

			..................

>Attoneys characteristically name every doctor who touched
>the patient in a lawsuit, even if the physician did nothing
>wrong, hoping to get them to finger-point.  Would the bar
>listen to a complaint that this is barratry?
>I doubt it.

This is not done for that reason.  It is the litigation law, which
makes it extremely difficult to add another person to the suit.  If
it is discovered in the questioning that it was Doctor X, who the
patient and his agents thought had a very minor role, really was the
one who made the big goof, and Doctor X was not mentioned in the suit,
the entire suit would have to be refiled, and another two years pass
before it gets heard.  It is also the law in many states that all
found guilty of any damages in a suit are together liable for the
damages, and this gives a way to collect if some are bankrupt.

>>Is it really true that physicians and dentists in the USA care
>>more about their patients than they care about money?  Is it 
>>really true that they base their decisions to treat or not to 
>>treat predominantly on the basis of patient benefit without 
>>regard to the money involved?

>I certainly do not take money into consideration, except that
>I try not to unnecessarily burden a patient or perform tests
>that are expensive and of marginal utility.  

I think that both of you are wrong.  I am not willing to accuse
the medical profession of pure venality, and I believe my reputation
on this group is not perceived as being anywhere near the medical
"party line."  On the other hand, I know, partly from personal
experience going back many years, that physicians do take into
account the costs to the patient.  However, they do not take into
account costs not paid by the patient directly, but which indirectly
costs, at this time mainly in insurance payments.  This has already
led to restrictions on treatment and billing practices, which are
not in the best interests of either the physicians or the patients.

>>I've noticed that many physicians like to blame problems on
>>consumerism and/or malpractice attorneys.  Yet, it seems to 
>>me that both consumerism and litigation are the responses
>>to existing problems and not the fundamental cause.

>They are a response to a problem, but an inappropriate one
>which causes other problems.  Ours is the only nation on
>the face of the earth that has chosen to handle our problems
>in this way, and we are paying for it.

Ours is the only nation which affords the patient any real redress
for even gross incompetence.  The laws should be changed, but only
to protect from misrepresentation or real incompetence.  But 
misrepresentation should include withholding of information, or
claiming the ability to do something, which may be licensed, but
where the ability is not there.

Physicians are as liable as most other people to jump to conclusions.
This misguided mental exercise had quite dire consequences.  It is
not just malfeasance, but nonfeasance, and the failure to recognize
that the problem is more complicated, which should be corrected.
I do not see much being done in this direction, and the currently
evolving cost-control procedures are likely to go farther toward
taking the consumer out of the decision-making process.
-- 
Herman Rubin, Dept. of Statistics, Purdue Univ., West Lafayette IN47907-1399
Phone: (317)494-6054
hrubin@pop.stat.purdue.edu (Internet, bitnet)  
{purdue,pur-ee}!pop.stat!hrubin(UUCP)
Newsgroups: sci.med,talk.politics.drugs,pnw.general