"Tort reform needs to be a top priority in health care"
Regarding "Reporting of errors may trigger minefield"
(Article, Feb. 14): AMA Immediate Past President Nancy W. Dickey, MD, is absolutely correct to say that, "Once we are sharing accountability with HMOs, we would be willing to share liability reforms with the
m."
Medical liability raises the cost of health care immeasurably because it compels physicians to practice defensive medicine. And it will do the same to managed care organizations by undermining their legitimate attempts to control health care costs. The
fact that HMOs have successfully fought off accountability attests to their tremendous lobbying power compared with organized medicine. It also explains why legislators have never accorded the issue of physicians' liability as much priority as they do HM
Os'.
Unless HMOs are made to feel at the corporate level the fears that physicians feel at the individual level, liability reform will not succeed. Every attempt should be made to convey this message to health insurers. Not as a threat or with hostility, bu
t as a sincere statement of what needs to be done to curb the one single factor that more than any other undermines our attempts to hold down the cost of health care.
Arbitration and any other methods that aim to settle malpractice disputes outside the courtroom need to be studied. Lawyers' fees should not be linked to the size of the awards. (Imagine if doctors were to charge patients according to the severity of t
heir illnesses.) Patients should receive their compensations speedily and not have to undergo the two- or four-year wait that currently prevails. Caps on pain and suffering and punitive awards need to be pursued.
Until the adversarial nature in our tort laws is extinguished, defensive medical practice -- whether performed individually by physicians or corporately by HMOs -- will be black holes in any health care system designed, sucking up medical resources at
a rate that far exceeds society's ability to pay for them.
Until a solution to the inadequate tort system is found, work in tort reform needs to be a top priority in health care.
--Edward J. Volpintesta, MD
Bethel, Conn.
Back to top
It's a rough world in medicine; get used to possibility of bruised ego
I read with interest and dismay your article "Medical student mistreatment"
(Article, Feb. 14). My heart was bleeding so much I was looking for the Band-Aids to swallow.
Better a bruised ego or wounded pride than an endangered or damaged patient down the line. It is a rough world out there, and most of the abuse that these students will get as they become physicians is from their own patients and the medical insurance
industry. The current vogue is that if you "feel" belittled or humiliated, you are. That attitude is common in sexual, racial and religious issues across the board.
I was belittled and on occasion humiliated. At the time, I did not feel it was deserved, but it was usually over an error that I had made or difficulty that I had caused for the residents, staff or attending staff. In the long run, that made me a far m
ore careful and better physician, even though at the time my ego was bruised a little bit. If the medical students think that they are being "abused by their brother physicians," they have yet to experience the abuse of the case managers in number crunche
s of the HMOs.
Sexual and racial abuse is a different issue, but the thrust of most of the complaints are not based on those issues but on bruised egos.
--Thomas J. O'Dowd, MD
Voorhees, N.J.
Back to top
Report on future of pediatric education sought wide input, not just views of a single organization
In your recent article "Pediatrics group forecasts shortage by subspecialists"
(Article, Feb. 28), there was a major error. The report referenced in the article was incorrectly attributed.
The report on which the article is based, but never mentions by name, is entitled "The Future of Pediatric Education II: Organizing Pediatric Education to Meet the Needs of Infants, Children, Adolescents and Young Adults in the 21st Century." It is not
a report of the American Academy of Pediatrics, contrary to your article. It is, in fact, a report of the entire pediatric community.
The FOPE II Project was a 3-year, grant-funded initiative that continued the work begun by the 1978 Task Force on the Future of Pediatric Education. When first conceived, it was determined that the FOPE II process should not represent the views of any
single organization or group of organizations. A task force composed of leaders in pediatric education was responsible for the overall direction of the FOPE II Project and for generating the final report. Throughout the course of the project, the task for
ce sought advice and input from a wide variety of knowledgeable and interested individuals and organizations.
The AAP is proud of the role we played as contributor to the FOPE II Project. But the project's success is due to the varied and extensive input from all across the pediatric map. Successful implementation of the report's recommendations will rely on t
he same such input.
--Errol R. Alden, MD
Principal investigator, FOPE II
Deputy executive director, AAP
--Holly J. Mulvey
Project director, FOPE II
Elk Grove Village, Ill.
Editor's note: Our news story also gave an incorrect first name for Dr. Alden. AMNews regrets these errors.
Back to top
Teen STAR: Condoms are not the only way to prevent premarital pregnancy
Regarding "Does sex ed focused on abstinence work?"
(Article, Jan. 17): Your article digests studies conducted by the Alan Guttmacher Institute and the Kaiser Family Foundation. While the Kaiser Foundation study polled a number of education resources, like an
y such poll it was incomplete and inevitably did not include all programs of education in human sexuality that, while comprehensive, aim at supporting virginity and/or a return to abstinent behavior.
Our own program, Teen STAR -- Sexuality Teaching in the context of Adult Responsibility, utilizes experiential learning of the body's fertility patterns together with discovery of the values involved (in sexual decisions).
Behavior change is usual for those in the program. In 1999 only 4% of 14- and 15-year-old female and male virgins transitioned to sexual activity, while up to 40% of previously active participants discontinued sexual activity. Currently the program ope
rates in 20 countries and has been reported in journals. The pessimistic picture projected by your article would lead one to believe that only the provision of contraceptives is useful in combating premarital pregnancy and STDs, when in fact the opposite
is true.
--Hanna Klaus, MD
Executive director
Teen STAR Program
Bethesda, Md.
Back to top
Unimpressed by British poll placing NHS as top achievement
I was very disturbed to see the item "Brits rate NHS as top achievement"
(AMNews, Jan. 31). Disturbed, I say, because one always wonders about any poll-taking.
One recognizes that poll-taking can be terribly stilted and painfully misleading depending on how the questions are asked.
I, for one, thoroughly question that the National Health Service is "the most important contribution of any British government in the 1900s."
--John R. Clark, MD
Payson, Utah
Back to top
Whistle-blowing rewarded, but not physicians who put patients first
A cover story
(Article, Feb. 28) states that a physician and his associate in Tennessee are $1.2 million in debt due (in part) to declining reimbursements. On page 4 there is a story
(AMNews, Feb. 28) regarding a fraud settlement at the University of Chicago. The whistle-blower in that case received $1.8 million for his role.
It is very unfair that our current system rewards whistle-blowers and penalizes doctors who make the good of their patients their highest priority.
--Luke A. Pluto, MD
Lewiston, Idaho
Back to top
Copyright 2000 American Medical Association. All rights reserved.
