The Physician’s Weekly #PWChat series continued last night with an energetic discussion focusing on defensive medicine and related costs. It was co-hosted by Jeff Segal, MD, JD, founder and CEO of Medical Justice, an organization that focuses on medical malpractice issues.

The conversation was sparked by one of Segal’s recent articles, Traditional Tort Reform Won’t Reduce Healthcare Costs.

You can view our upcoming schedule, or read our other #PWChat recaps here.

Below are the highlights from the chat. You can read the full transcript here.

 

 

Question 1

Q1: What do we currently know about the negative impacts of defensive medicine?#PWChat

— Physician’s Weekly (@physicianswkly) July 13, 2017

A1: It’s expensive. Nobody knows how expensive. > $100 & < 650B/yr. Those $ not value-add. Just to avoid hot seat in court. #PWChat (1/3)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A1: Everybody does it. One researcher said 91% practice defensively. The other 9% are liars. #PWChat (2/3)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A1: TRADITIONAL tort reform hasn’t has cut defensive medicine. Why? No MD wants to be sued. Whether for $1 or $1M. #PWChat (3/3)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

Over time #DefensiveMedicine morphs into #StandardOfCare #NaturalSelection #PWchat

— Art Fougner (@sonodoc99) July 13, 2017


Question 2

Q2: Pres Trump proposes to cap damages on pain and suffering to $250,000 per claim, limit attorneys’ fees (1/2)#PWChat

— Physician’s Weekly (@physicianswkly) July 13, 2017

and limit the period to file lawsuits among other traditional tort reform efforts. Will this approach work? Why/why not? (2/2)#PWChat

— Physician’s Weekly (@physicianswkly) July 13, 2017

A2: Will it pass? It passed the House. Next up, Senate. Often, need 60 votes. If this threshold, likelihood passing slim. #PWChat (1/4)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A2: In Senate, may only need 50 votes if “budget reconciliation” with $ saved to federal gvmt. This threshold MAY be met. #PWChat (2/4)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A2: Will need to see how this gets characterized. #PWChat (3/4)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A2: Even 50 votes hard. Some conservatives argue feds have no business dealing with med mal– traditionally province of states. #PWChat (4/4)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017


Question 3

Q3: What are the benefits of traditional tort reform?#PWChat

— Physician’s Weekly (@physicianswkly) July 13, 2017

A3: Lower med mal premiums. Perhaps lower frequency of litigation. (Lawyers receive less $. Less incentive to take case.) #PWChat

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

med mal litigators need physicians too. Stop offering elective care to them. Can one be objective with them?

— Dr. Roy Stoller (@DrRoyStoller) July 13, 2017


Question 4

Q4: What are the problems with traditional tort reform?#PWChat

— Physician’s Weekly (@physicianswkly) July 13, 2017

A4: Does not impact defensive medicine. Tackling defensive medicine has opportunity to lower HEALTH insurance premiums. #PWChat (1/4)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A4. And, if you are sued, you still have “cage fight” adversarial process. #PWChat (2/4)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A4: Finally, if pts have no easy way to redress perceived problems, they complain to Board or slam doctor on Internet. #PWChat (3/4)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A4. Nature abhors a vacuum. #PWChat (4/4)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017


Question 5

Q5: Why would physicians continue practicing defensive medicine despite statutes to limit their damages in malpractice suits?#PWChat

— Physician’s Weekly (@physicianswkly) July 13, 2017

A5: Old habits die hard. But, docs don’t want to be sued. For $1 or $1M. So, they do everything to avoid an odious process. #PWChat (1/6)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A5: Litigation is adversarial. Med mal is assault on reputation. Judged by 12 laypersons who don’t know medicine. #PWChat (2/6)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

Q5 force of habit baked into processes?

— Matthew Loxton (@mloxton) July 13, 2017

A5: Defensive medicine is rational behavior. #PWChat (6/6)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017


QUESTION 6

In last night’s #PWChat w/ @jeffsegalmd, we forgot Q6: What alternatives are there to traditional tort reform? Let’s keep discussion going!

— Physician’s Weekly (@physicianswkly) July 13, 2017

A6: I’m a fan of no-fault systems. Used in almost every other country around the world. #PWChat (1/2)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A6: Non-adversarial. Pts get near-term predictable, REASONABLE remedy for avoidable injuries. #PWChat (2/2)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017


Question 7

Q7: What are the benefits of no-blame systems? How do they work? #PWChat

— Physician’s Weekly (@physicianswkly) July 13, 2017

A7: Benefits. Nest egg NOT at risk. Non-adversarial. You can accompany patient and advocate on their behalf if you’d like. #PWChat (1/6)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A7. Or not show up if you’d like. Less expensive than current system. Resolution occurs within months, not years. Less stigma. #PWChat (2/6)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A7: How they work. Patient files request to investigate injury for potential compensation. #PWChat (3/6)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A7: Expert panel in same specialty reviews (on round robin basis) the case. #PWChat (4/6)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017


Question 8

Q8: Do clinicians practice defensive medicine in other countries?#PWChat

— Physician’s Weekly (@physicianswkly) July 13, 2017

A8: No. In survey of other countries asking if they practiced defensively, typical response was “What’s defensive medicine?” #PWChat (1/3)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A8: Study researched avoiding unnecessary CT scans after minor head injury. But prevent pt with intracranial bleed leaving ER. #PWChat (2/3)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A8: CANADIAN Head CT Study. That study would have hard time being done in US. #PWChat (3/3)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017


Question 9

Q9: Hand-in hand w/ Q8, are clinicians sued in other countries as they are in the U.S.?#PWChat

— Physician’s Weekly (@physicianswkly) July 13, 2017

A9: Americans are uniquely litigious compared to other countries. #PWChat (1/3)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A9: eg: the ratio of lawyers/engineers in US is inverse to that of Japan. #PWChat (2/3)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017

A9: It’s been said if there’s only one lawyer in a small town, he’ll starve. Two lawyers and they’ll each make a fortune. #PWChat (3/3)

— Jeffrey Segal (@jeffsegalmd) July 13, 2017