 June 2002 • Volume 8 • Number 6 |
Rule No. 1: Physicians should never see patients. Rule No. 2: Physicians should keep all patients deliriously happy at all times.
Sound ridiculous?
Impossible?
Of course -- but only by following these rules can physicians avoid all potential liability lawsuits, said AAFP Board Chair Richard Roberts, M.D., J.D., of Madison, Wis., during a May 6 teleconference on the issue. In other words, practicing medicine inevitably involves certain risks, such as the risk of being sued.
The teleconference was designed to help FPs cope with the medical liability crisis. About 300 AAFP members, leaders and staff participated in the teleconference, which is available to other members online at http://www.aafp.org/confcall/ (see the instructions on the bottom of the Web page).
Insurers continue to leave the physician liability business because of high loss ratios. The frequency of liability cases is on the rise, and juries are awarding larger and larger awards.
The result? Exorbitant liability insurance premiums in many states, Roberts said. For example, physicians practicing obstetrics and gynecology in some Florida counties now pay $209,000 annually for $250,000 of insurance coverage. "That's very nearly being self-insured," he said.
Insurance prices and pressures also are prompting significant changes. "Malpractice is a profound experience," Roberts said. "It changes how physicians look at themselves and how they practice."
To illustrate the point, Roberts cited a study of 220 Cook County, Ill., physicians who had fought medical liability cases.
The study found, he said, that 90 percent of the doctors suffered significant mental effects from the lawsuits. After the cases ended, half of them stopped offering certain services; another 50 percent dropped certain types of patients. However, the most disturbing effect was that 10 percent of the doctors contemplated suicide.
Patients also suffer when they initiate a lawsuit, Roberts said, "and we shouldn't forget that."
When patients consider filing a lawsuit, they must weigh their personal costs as well. If they sue, plaintiffs face only a 25 percent chance of winning, and they, too, must reveal much of their personal lives in the public arena, he said.
"And the public is still confused about who should take the blame," Roberts said. "We all look like villains to them -- lawyers, doctors and insurance companies."
Medical organizations across the country, including the Academy, continue to fight for judicial reforms in state medical liability systems. This year, several states passed tort reforms that could lead to lower insurance premiums.
The most effective tort reforms, Roberts said, place a cap on noneconomic damages (usually $250,000), reduce the statute of limitations (from the time of injury to the filing of the suit) to three years or fewer for adults, and limit attorney fees so more money goes to the injured patient. Together, these reforms could help decrease premiums by up to 25 percent, Roberts said. California was the first state to enact such reforms, back in 1975.
On April 25, the battle moved to the national level when Rep. James Greenwood, R-Pa., introduced legislation seeking federal medical liability reform. H.R. 4600 very nearly mirrors the reforms listed above. At press time, the bill was being considered in the House Subcommittee on Health and had 18 cosponsors. The Academy supports the bill because "the reforms in this bill have already brought stability and fairness to the California legal system for the past 25 years," Roberts wrote in an April 24 letter of support addressed to Greenwood.
"What are the chances of H.R. 4600 passing?" FP Timothy Alford, M.D., of Kosciusko, Miss., asked Roberts during the teleconference.
"My own view of the probability of getting a national fix is pretty low," Roberts answered. "Any federal help would be great! However, I favor helping people like you in the individual states."
In the meantime, doctors should continue to educate their patients about important health issues and take every opportunity to talk to them, Roberts told conferees during the May 6 call.
Also, use risk management in your practice, he said. For instance:
"Medical liability is a huge problem," Roberts said in closing. "Ultimately, it affects the public's health. So don't lose faith."
To advocate passage of H.R. 4600, visit http://capitol.aafp.org/aafp/issues/?style=D at Speak Out: AAFP Legislative Action Center, and click on "Support H.R. 4600 and Bring Stability Back to the Professional Liability Market." Enter your ZIP code, and e-mail the letter to your federal lawmakers.
FP Report is published by the
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Copyright © 2002 by
American Academy of Family Physicians.