Nobody asked us

Health Care Reform? We're sick to death of the debate. Cliché after sound bite after jingle… For all the expert opinions, we sense none of them really know the issues. In fact, the statements of the politicians, ivory tower physicians and societal spokespersons don't ring true at all. It's the docs in the pits that really know the issues.

I couldn't put my finger on it for a long time. But when the president spoke to the AMA in Chicago and made the pronouncement that litigation reform was not part of the solution, I knew nothing good could come of it. Either he didn't have a clue what he was talking about, or his party was just too beholden to the legal profession. For anyone to not realize that the whole medical profession had been terribly and probably irrevocably altered by fear of medical lawsuits, meant that he was either too out of touch, or on the wrong side, to ever help things.

That Cover Your Ass (CYA) mindset didn't just appear without cause. Good doctors were accused, tried and sentenced based on meritless, illogical cases again and again. In response, we began ordering more tests, more treatments, more admissions ("just to watch patients") in an effort to minimize our exposure. It costs a lot of money, but no one ever calls to thank you for saving the nation's health care system money, do they? Lawyers and nonsense lawsuits aren't just part of the problem. Medical malpractice has become the greatest part of the problem. When we stopped doing the right thing for the patients and started worrying about our vulnerability to a legal system that operated on the greed principal, the die was cast.

How did we ever get into this mess? Medicine had operated effectively "government free" for generations.? There was an important passing of the torch from senior to junior. Young doctors were mentored by older ones. Internal reviews of quality had their place, but the inherent passion of physicians to do their absolute best for their patients was the proud tradition that guaranteed excellence. When this president accused us of scheming to "cut diabetic feet off to make thousands of dollars," it showed how little he knew of doctors. More importantly, it showed how little he respected doctors.

Was it a need for insuring care for all that led the government to take over? Charity care used to be a given. It was an unwritten law that all doctors helped those who couldn't pay, the so called "deserved poor". Dispensed by individuals and charitable groups since the founding of this country, the system allowed the simply lazy to be cut off. Charity work was just part of the package, not done because of fear of litigation or legal declaration. It was just the right thing to do, and it worked. My elder colleagues assure me that the poor and aged weren't dying on the sidewalks and in the gutters prior to Medicare and Medicaid.

We are scientists. We would love to help every ill and save every patient but we are also realists. As stewards of our limited resources, we know that it makes no sense to order 10,000 negative CAT scans to find one patient with a subdural we might be able to help. We know it is bad medicine to order chest x rays and antibiotics on every patient with a cough, in case one of them might have a bacterial pneumonia. We need to use those resources in the most cost effective manner, get the biggest bang for the buck. It is craziness to do otherwise. Now that craziness has a name. It's called CYA.

Lunacy is what it has become. How did medicine become the province of politicians and attorneys who made statements like, "Defensive medicine?" There are a lot of tests that have little or no risk. I want every last test that can possibly be done on me to be done. I don't call that defensive medicine. I call that "cautious medicine". The inmates are running the asylum.

Even our allies are out of touch. Official estimates of the cost of defensive medicine are pitifully low. Hell, a good third of the patients I now see in my inner city Emergency Department (ED) don't belong there at all. Out of fear that one out of a million drops dead after being deflected to our clinics or their Private Medical Doctors (PMDs), we see millions of them in the ED annually. That's part of the cost of defensive medicine too. All things considered, greater than 50% of all tests, procedures, treatments, and admissions are done for fear of litigation and not for patient care. Skeptical? Check out the percent of positive x-rays any doctor ordered in the last shift.

Generations of doctors have trained in this CYA era. It's questionable if it could be reversed. One thing I know is certain. Want to cut health care costs dramatically? Want to do it in a way where patients win, taxpayers win, and even doctors win? Rein back the cancer of frivolous malpractice suits. Without it, there is no real intention to help the problem. The vast majority of honest, driven, altruistic doctors deserve no less. We need to fiercely demand it, loudly and repeatedly.

Don't believe it Mr. Congressman? Come, work a shift with me. Bring your calculator.