In the current push for national health insurance, expensive overuse of technology based on the defensive practice of medicine by doctors is being overlooked. Yet doctors often over-order tests and treatments for fear of missing a remote diagnosis. Doctors are afraid of being sued by the same aggressive trial lawyers who lobby Congress against real reform. Keep in mind that it isn’t just a dreaded error like removing the wrong kidney that motivates doctors to practice defensively, it is the fear of lawyers and having to meet with them as part and parcel of responding to arbitrary lawsuits. Doctors who have done nothing wrong can be targeted with frivolous suits that drag them into the lawyer’s office. The process of having your records scrutinized in an effort to determine how well you’ve documented things and if you’ve made errors can be instructive, but it can also be humiliating. This process can alter the way a doctor practices as he or she struggles to avoid the nightmare of legal exposure in future.

Though 98,000 people die in U.S. hospitals every year from medical mistakes, at the same time according to a recent Harvard study, 40 percent of malpractice lawsuits are not legitimate, though they lead to 15 percent of the money paid out. Often times the doctors who are sued did nothing wrong, while those who make mistakes too often escape retribution.

Most malpractice cases are won by doctors, but not before they endure the protracted painful process of meeting with lawyers. Many doctors quit medicine or become even more defensive and order more and more unnecessary tests as a result. I remember when the best urologist and one of the top cardiologists at my hospital quit practice abruptly because of extended lawsuits where they weren’t at fault.

On the defense side, lawyers may milk doctors for billable time, and on the plaintiff side, ambulance chasers thrive, creating and exploiting frivolous cases for profit. Many patients get unnecessary operations because of defensive medicine. C-section is on the rise and is vastly overdone because of doctors fearing lawsuits. There is a culture of fear that motivates doctors to practice defensively, which causes costs to skyrocket.

With the possible rationing of care that may occur in the name of cost control under an expanded system, malpractice could skyrocket as more and more tests and procedures are denied yet doctors continue to be blamed when something goes wrong. It is especially problematic that neither insurers nor the government have direct legal responsibility while at the same time turning down tests. Most doctors are too busy and too scared of being singled out to band together to protest this uneven system.

What is the solution? One solution is to create state review boards like Michigan or Tennessee to limit frivolous lawsuits. Doctors and lawyers can serve on these boards together and provide a barrier to nuisance suits. More peer review in the hospitals is also a good idea, regular mortality and morbidity conferences where doctors behavior is examined without the direct fear of lawsuits.

Capping pain and suffering awards would seem like a simple enough solution, but some patients truly deserve a high reward if they’ve been badly mistreated by a physician (as when the wrong organ is removed or a diagnosis is blatantly missed). A better initial approach is to target nuisance suits for destruction.

It is estimated that tort reform can lead to an initial savings of 2% on health care costs, without even considering the billions of dollars that will be saved by decreasing the defensive practice of medicine (based on overuse). But even with tort reform, the current plans for health insurance reform combined with decreased reimbursements to hospitals and doctors will lead to more and more patients being seen in shorter periods of time. This will lead to more and more medical mistakes, and more and more malpractice.

There hasn’t been much of a push yet to combine tort reform with the current health insurance reform initiative being considered by Congress. This could change. The Democrats could decide to add some tort reform (probably Caps to pain and suffering) as a sweetener to a bitter pill (or bill). This might cause more physicians to support the current health reform, but would do nothing to correct the larger problem of physician dissatisfaction, overwork, attrition, and scarcity, all of which lead to medical mistakes.

Plus, simply capping pain and suffering is not a guarantee that doctors will see their liability insurance premiums lowered. In California in the 1980s, when a cap on pain of suffering to $250,000 was first initiated, there was no overall savings to physicians. Instead, the insurance companies made more profits. It took an additional law to ensure that the savings was transferred to physicians in terms of lower premiums.  

It is the current insurance-oriented climate for practicing medicine that must be changed before doctors (and their patients) will reach any kind of comfort level or be able to cut costs in a reasonable way. Insurance of both kinds (private and public) is the problem, not the solution. Costs spiral upward because of doctors’ fear of malpractice and rush to see more and more patients in a short period of time amid shrinking reimbursements. The easiest way to do this if you’re a primary care doctor is to quickly refer a patient to a specialist of for an expensive test, jacking up costs. At the same time, patients are inclined to overuse their health insurance because they don’t pay for each procedure or as many have put it, because patients don’t have any “skin in the game.”

Tort reform is essential and must include not only caps on pain and suffering and reflected decreases in liability premiums, but also a way to ferret out nuisance suites. I am in favor of more peer review in the hospitals as well as a lawyer and doctor staffed board in every state to review claims before they are brought. I strongly believe that private insurance companies as well as the government (Medicare and Medicaid), should incur liability themselves for tests they decline.

But I do not think that any of this should be done as a way to manipulate physicians to support a kind of health reform that is not in our best interest, or in the best interest of our patients.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.” Read more at www.doctorsiegel.com

While the Obama administration pushes for national health insurance, expensive overuse of technology based on the defensive practice of medicine by doctors is not being considered at all. Doctors over order tests and treatments for fear of missing a remote diagnosis. Doctors are afraid of being sued by aggressive trial lawyers who lobby Congress against real reform.

Though 98,000 people die in U.S. hospitals every year from medical mistakes, at the same time according to a recent Harvard study, 40 percent of malpractice lawsuits are not legitimate, though they lead to 15 percent of the money paid out. Often times the doctors who are sued did nothing wrong, while those who make mistakes too often escape retribution.

Most malpractice cases are won by doctors, but they suffer a long-extended process first where they must meet with lawyers. I know many doctors who have quit medicine or become even more defensive and ordered more unnecessary tests as a result. I remember when the best urologist and one of the top cardiologists at my hospital quit practice abruptly because of extended lawsuits where they weren’t at fault.

On the defense side, lawyers milk doctors for billable time, and on the plaintiff side, ambulance chasers thrive, creating and exploiting frivolous cases for profit.

Many patients get unnecessary operations because of defensive medicine. C-section is on the rise and is vastly overdone because of doctors fearing lawsuits. There is a culture of fear that motivates doctors to practice defensively, which causes costs to skyrocket.

With rationing of care that is inevitable under the Obama health care reform, especially with a public option, malpractice will skyrocket because tests and procedures will be denied and doctors will be blamed. Yet we doctors are too busy and too scared of being singled out to band together to resist.

What is the solution? One solution is to create state review boards like Michigan has to limit frivolous lawsuits. Doctors and lawyers can serve on these boards together and provide a barrier to nuisance suits. More peer review in the hospitals is also a good idea, regular mortality and morbidity conferences where doctors behavior is examined without the fear of lawsuits.

Capping pain and suffering awards would seem like a simple enough solution, but some patients truly deserve a high reward if they’ve been badly mistreated by a physician (as when the wrong organ is removed or a diagnosis is blatantly missed). A better approach is to target nuisance suits for destruction.

Dr. Marc Siegel is an internist and associate professor of medicine at the NYU School of Medicine. He is a FOX News medical contributor and writes a health column for the LA Times, where he examines TV and movies for medical accuracy. Dr. Siegel is the author of “False Alarm: The Truth About the Epidemic of Fear“ and “Bird Flu: Everything You Need to Know About the Next Pandemic.”  Read more at www.doctorsiegel.com

Today we heard the news that former Senate Majority Leader Tom Daschle has accepted President-elect Barack Obama’s offer to serve as Secretary of Health and Human Services. It seems to me that Obama is willing to hit the ground running and might make healthcare reform one of his top priorities.

I had the pleasure of meeting Senator Daschle years ago, and I left with the impression that he was quite knowledgeable in healthcare issues and indeed was very attentive to my concerns. But, as I said, that was many years ago.

So, what do we know so far about Senator Daschle’s credentials? Well, we can get an idea by looking at his voting record and some quotes from previous interviews.

Here’s what we know so far:

Senator Daschle supports a government-funded insurance program for the uninsured. Since 2004, he has been stipulating that everyone should have the same healthcare plan as members of Congress.

Another interesting concept that Senator Daschle likes is the creation of a Federal Health Board. Now, I’m not quite sure yet what he means by that, but it seems that this board could act as a federal clearinghouse for healthcare mandates.

With regard to his voting record, I give Senator Daschle a B+. He understands the national nursing shortage we are experiencing, and he has voted “yes” on allowing patients to sue HMOs and collect punitive damages. However, he voted “no” on limiting self-employment health deductions.

I’ll go on the record and say that when it comes to healthcare, I think that Daschle has demonstrated a balanced approach to his decisions. And, in the weeks to come, we should be getting a clearer picture of his immediate priorities.

Hopefully Senator Daschle and I will get the chance to have a one on one again soon. In the meantime, let’s all congratulate our new Secretary of Health and Human Services and wish him well―he’s got a big job ahead of him.

But let him not forget that it is important to evaluate all points of view and to maintain transparency in all aspects of healthcare reform. This is a change we must all expect.

The other day I was asked if I expected an increase in the number of babies that I will be delivering in 2009 and I said “Absolutely, I expect an Obama baby boom.”

Now this is a topic that I know a lot about. Pregnancies come in cycles. I mean let’s face it, some pregnancies are accidental, some pregnancies are planned. But the trend has always been that life-changing events tend to bring people together. And you know what happens when we bring people together―nine months later, we have a blessed child.

I don’t know what it is about these life-changing events―maybe fear or euphoria is the most attractive indicator―but nonetheless, as someone who runs a hospital that delivers more than 6,000 babies a year, I have a pretty good idea when we can expect our birth rates to go up.

Now let’s talk about those life-changing events. Politics in and of itself does not make a very sexy scenario to plan a pregnancy. But I can go as far back as 1961 with the election of John F. Kennedy to tell you that following his election cycle, we saw an increase in births. The last four Republican presidents have also seen a spike in the birth rate during their presidencies. So if the trend continues, I do expect president-elect Obama to give us a significant increase in the national birth rate.

However, I think that this Obama baby boom might be more significant than others. The reason? There are two key factors president-elect Obama is bringing to the table that we have not seen on a national level in many years. Number one: Obama has such a positive optimism in some of the changes he has offered, which have resonated in the psyche of many Americans. And two: One of the top priorities on president-elect Obama’s agenda that he would like to try to accomplish in the early phases of his presidency is healthcare reform.

So I hope that president-elect Obama sets his sights on women’s healthcare with a focus on giving women the access to prenatal care that they truly deserve. Yes, this is going to be “change that you can believe in.”