Letters to the Editor - April 17, 2006

Performance pay plans will increase paperwork burden for physicians - A hired-gun witness can be exposed by a good liability defense attorney

Performance pay plans will increase paperwork burden for physicians

As I see it, pay-for-performance is another way to penalize primary care physicians who practice in the most difficult circumstances -- in underserved communities with the sickest patients who have the least resources. I see it as another way nonphysicians are making demands on us without any idea of the realities of a clinical practice.

I see it as more nonproductive and, you can be sure, noncompensated paperwork. The idea of shifting through hundreds of records to mine data so some entity can have another reason to deny payment for my services is revolting.

Most of my visits with patients are spent filling out forms. Recently I have noted the abuse of the four-page Family Medical Leave Act forms for trivial complaints, the proliferation of HMO referral forms in triplicate and unrealistic demands for $6,000 motorized vehicles.

I think it is time we just say no. If we do not, I fear this is only the beginning of being dictated to by insurers, lawyers, MBAs and the government.

--Dean Raffaelli, DO, Chicago

A hired-gun witness can be exposed by a good liability defense attorney

Regarding "Medical community holds answer to problem of rogue expert witnesses" (Letters, Feb. 6): Many doctors conveniently blame the malpractice situation on out-of-state plaintiffs' experts-for-hire who come to trial and testify against wrongly accused defendant doctors. The party line goes that if we can restrict them from coming in the state by requiring certificates or licensing, the malpractice climate will improve.

The assumption involved in this fallacious reasoning is that only out-of-state plaintiff experts-for-hire stretch the truth or outright lie. Obviously no defense expert would do so, as they stand for truth, justice and the American way. Nothing could be further from the truth.

I have reviewed many defense depositions from both in-state and out-of-state experts that leave me wondering on what planet do they practice. A good defense attorney should be able to devour a plaintiff expert who is way off base and expose him as a hired gun when he gives obviously absurd opinions. To blame the problem on a bunch of plaintiff experts-for-hire is ridiculous.

--Lee Fischer, MD, West Palm Beach, Fla.