<?xml version="1.0" encoding="UTF-8"?><rss version="2.0" xmlns:content="http://purl.org/rss/1.0/modules/content/" xmlns:dc="http://purl.org/dc/elements/1.1/" xmlns:atom="http://www.w3.org/2005/Atom" xmlns:sy="http://purl.org/rss/1.0/modules/syndication/" xmlns:georss="http://www.georss.org/georss" xmlns:geo="http://www.w3.org/2003/01/geo/wgs84_pos#" > <channel> <title> Comments on: The 800-Pound Gorilla in the Healthcare Living Room </title> <atom:link href="https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/feed/" rel="self" type="application/rss+xml" /> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/</link> <description>'The Green Journal'</description> <lastBuildDate>Mon, 22 Jul 2013 23:48:13 +0000</lastBuildDate> <sy:updatePeriod> hourly </sy:updatePeriod> <sy:updateFrequency> 1 </sy:updateFrequency> <item> <title> By: Andre645 </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-212</link> <dc:creator><![CDATA[Andre645]]></dc:creator> <pubDate>Sun, 08 May 2011 19:41:15 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-212</guid> <description><![CDATA[OK, let's cut costs, eliminate "unnecessary" tests and stop practicing "DEFENSIVE" medicine. But, BEWARE!!! A cautionary tale is the case of a small boy seen in the E.R. of a major Northern California teaching hospital. He had been struck in the head by a baseball during a little league game. UC Professors and hospital administrators had decided they would trim huge medical bills inflicted on patients so they eliminated routine skull X-rays for head injuries with no apparent neurologic deficit. The boy was sent home with standard head instructions... Observe for L of C, N & V, etc. During the night he lapsed into a coma. Returning to the hospital skull X-rays showed a linear fracture in the parietal bone, right through the area of the middle meningeal artery - A HUGE RED FLAG. He suffered permament brain damage. A jury was NOT sympathetic to the cost-cutting measures and awarded a multimillion dollar judgement in the inevitable medical malpratice lawsuit.]]></description> <content:encoded><![CDATA[<p>OK, let’s cut costs, eliminate “unnecessary” tests and stop practicing “DEFENSIVE” medicine. But, BEWARE!!! A cautionary tale is the case of a small boy seen in the E.R. of a major Northern California teaching hospital. He had been struck in the head by a baseball during a little league game. UC Professors and hospital administrators had decided they would trim huge medical bills inflicted on patients so they eliminated routine skull X-rays for head injuries with no apparent neurologic deficit. The boy was sent home with standard head instructions… Observe for L of C, N & V, etc. During the night he lapsed into a coma. Returning to the hospital skull X-rays showed a linear fracture in the parietal bone, right through the area of the middle meningeal artery – A HUGE RED FLAG. He suffered permament brain damage. A jury was NOT sympathetic to the cost-cutting measures and awarded a multimillion dollar judgement in the inevitable medical malpratice lawsuit.</p> ]]></content:encoded> </item> <item> <title> By: Joseph Alpert </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-211</link> <dc:creator><![CDATA[Joseph Alpert]]></dc:creator> <pubDate>Sat, 07 May 2011 00:18:27 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-211</guid> <description><![CDATA[Again, I would like to thank the bloggers for their incisive comments. There is not one word that has been written here that I do not agree with. We need to keep pushing our elected officials to pass tort reform and then we need to set standards for practice(for example guidelines from recognized professional organizations such as the American Heart Assn/American College of Cardiology) that could be embedded in our EMRs together with the MDs orders and these would forever represent clear evidence that correct medical practice was followed. Joseph Alpert]]></description> <content:encoded><![CDATA[<p>Again, I would like to thank the bloggers for their incisive comments. There is not one word that has been written here that I do not agree with. We need to keep pushing our elected officials to pass tort reform and then we need to set standards for practice(for example guidelines from recognized professional organizations such as the American Heart Assn/American College of Cardiology) that could be embedded in our EMRs together with the MDs orders and these would forever represent clear evidence that correct medical practice was followed. Joseph Alpert</p> ]]></content:encoded> </item> <item> <title> By: Stanley J. Zimmerman, M.D., FACE, FACP, FACN </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-210</link> <dc:creator><![CDATA[Stanley J. Zimmerman, M.D., FACE, FACP, FACN]]></dc:creator> <pubDate>Thu, 28 Apr 2011 15:10:16 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-210</guid> <description><![CDATA[Dr. Alpert:<br /><br />I enjoyed reading your editorial “The 800-Pound Gorilla in the Healthcare Living Room”. Each and every point you made was so important to the practice of medicine. We were extremely lucky to begin practice in the “Golden Age of Medicine” when physicians were revered and we were in charge and we were also respected. As a dinosaur, I remember the days in which when we wrote orders and the nurses, pharmacists, physical therapists, and social workers carried them out. They supported us and gave suggestions. It was very much like the military with the physicians serving as captains and the other members of “the team” were lieutenants, sergeants, and privates. Today we are all treated equally and the spirit of yesterday of supporting each other is gone. It is now each member of the team is equal and the effort to take care of the patient is made more difficult. There is a progression toward “protocols” which are carried out in the hospitals and even in our practices in which nursing and physician care is governed by protocols. The eye-to-eye contact with patients and hands- on is dying out and we have forgotten that each patient is an individual and is different. It used to be termed the practice of medicine in which we as physicians and nurses practiced everyday in order to learn more and to improve our patient care. I have a saying, which I have applied to myself as well as to the students who rotate through our clinic, in which “we don’t know what we don’t know”. This becomes obvious as we read the many journals and attend conferences in which new information is presented and many times what was old becomes new again. <br /><br />We need more editorials, such as the one you wrote, to keep our spirits alive and help us remember what the practice of medicine was like.]]></description> <content:encoded><![CDATA[<p>Dr. Alpert:</p> <p>I enjoyed reading your editorial “The 800-Pound Gorilla in the Healthcare Living Room”. Each and every point you made was so important to the practice of medicine. We were extremely lucky to begin practice in the “Golden Age of Medicine” when physicians were revered and we were in charge and we were also respected. As a dinosaur, I remember the days in which when we wrote orders and the nurses, pharmacists, physical therapists, and social workers carried them out. They supported us and gave suggestions. It was very much like the military with the physicians serving as captains and the other members of “the team” were lieutenants, sergeants, and privates. Today we are all treated equally and the spirit of yesterday of supporting each other is gone. It is now each member of the team is equal and the effort to take care of the patient is made more difficult. There is a progression toward “protocols” which are carried out in the hospitals and even in our practices in which nursing and physician care is governed by protocols. The eye-to-eye contact with patients and hands- on is dying out and we have forgotten that each patient is an individual and is different. It used to be termed the practice of medicine in which we as physicians and nurses practiced everyday in order to learn more and to improve our patient care. I have a saying, which I have applied to myself as well as to the students who rotate through our clinic, in which “we don’t know what we don’t know”. This becomes obvious as we read the many journals and attend conferences in which new information is presented and many times what was old becomes new again. </p> <p>We need more editorials, such as the one you wrote, to keep our spirits alive and help us remember what the practice of medicine was like.</p> ]]></content:encoded> </item> <item> <title> By: Dave Winchester </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-209</link> <dc:creator><![CDATA[Dave Winchester]]></dc:creator> <pubDate>Sun, 24 Apr 2011 22:29:04 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-209</guid> <description><![CDATA[I just got around to reading your editorial and wanted to echo the many supportive comments. What I found most refreshing and notable about the editorial is its publication in a journal widely read by academic physicians. I am completing my training as a Cardiology fellow and have long been involved in a variety of organized medicine and legislative efforts at tort reform. One of my major frustrations has been the denial rampant among my colleagues and attendings who do not see tort reform as a notable problem. I hope your words continue to bring awareness to this issue.]]></description> <content:encoded><![CDATA[<p>I just got around to reading your editorial and wanted to echo the many supportive comments. What I found most refreshing and notable about the editorial is its publication in a journal widely read by academic physicians. I am completing my training as a Cardiology fellow and have long been involved in a variety of organized medicine and legislative efforts at tort reform. One of my major frustrations has been the denial rampant among my colleagues and attendings who do not see tort reform as a notable problem. I hope your words continue to bring awareness to this issue.</p> ]]></content:encoded> </item> <item> <title> By: Joseph Alpert </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-208</link> <dc:creator><![CDATA[Joseph Alpert]]></dc:creator> <pubDate>Sun, 24 Apr 2011 15:49:45 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-208</guid> <description><![CDATA[I was both happy and surprised to see how many MDs responded positively to this editorial. Our managing editor, Pam Powers, has written an excellent summary of the discussion at the top of this month's blog page. I am hoping that our representatives in DC will recognize that defensive medicine is one of the main factors fueling the rapidly increasing cost of medical care in the US. Other technically advanced countries with the same level of care as the US, for example, Canada, France, Denmark, Sweden, Germany, etc. have better healthcare statistics (mortality for example) at considerably less cost. Malpractice is much, much less of a problem in these countries and hence defensive medicine is essentially non-existent in these nations. Joseph Alpert]]></description> <content:encoded><![CDATA[<p>I was both happy and surprised to see how many MDs responded positively to this editorial. Our managing editor, Pam Powers, has written an excellent summary of the discussion at the top of this month’s blog page. I am hoping that our representatives in DC will recognize that defensive medicine is one of the main factors fueling the rapidly increasing cost of medical care in the US. Other technically advanced countries with the same level of care as the US, for example, Canada, France, Denmark, Sweden, Germany, etc. have better healthcare statistics (mortality for example) at considerably less cost. Malpractice is much, much less of a problem in these countries and hence defensive medicine is essentially non-existent in these nations. Joseph Alpert</p> ]]></content:encoded> </item> <item> <title> By: happy internist </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-207</link> <dc:creator><![CDATA[happy internist]]></dc:creator> <pubDate>Thu, 14 Apr 2011 16:26:20 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-207</guid> <description><![CDATA[very nice, concise, article. i am a practicing general internist and i deal with this every day. i would only add that an equally big gorilla is the patient's own unwillingness to accept uncertainty. there is as often as much push from the patient to do all those tests as there is pressure from my own liability-influenced psyche.]]></description> <content:encoded><![CDATA[<p>very nice, concise, article. i am a practicing general internist and i deal with this every day. i would only add that an equally big gorilla is the patient’s own unwillingness to accept uncertainty. there is as often as much push from the patient to do all those tests as there is pressure from my own liability-influenced psyche.</p> ]]></content:encoded> </item> <item> <title> By: Anne Thorndike, MD </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-206</link> <dc:creator><![CDATA[Anne Thorndike, MD]]></dc:creator> <pubDate>Tue, 05 Apr 2011 02:42:59 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-206</guid> <description><![CDATA[Dr. Alpert-<br />I wholeheartedly agree with your editorial. In particular, I am happy to see you dispute the often quoted argument that tort reform in the US would result in only minimal savings of healthcare dollars. The costs of medical malpractice go far beyond the actual payouts and legal fees. The threat of malpractice has been internalized into our day to day practice of medicine, and I think we often do not recognize it as the driver of many of our "defensive" practices.]]></description> <content:encoded><![CDATA[<p>Dr. Alpert-<br />I wholeheartedly agree with your editorial. In particular, I am happy to see you dispute the often quoted argument that tort reform in the US would result in only minimal savings of healthcare dollars. The costs of medical malpractice go far beyond the actual payouts and legal fees. The threat of malpractice has been internalized into our day to day practice of medicine, and I think we often do not recognize it as the driver of many of our “defensive” practices.</p> ]]></content:encoded> </item> <item> <title> By: AJM Guest Author </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-205</link> <dc:creator><![CDATA[AJM Guest Author]]></dc:creator> <pubDate>Fri, 01 Apr 2011 22:32:11 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-205</guid> <description><![CDATA[In his recent editorial, Dr. Joseph Alpert (1) discussed his dissatisfaction with the way the legal system deals with medical malpractice and how the threat of malpractice suits pressure doctors to order unnecessary tests so they have a good defense in case a suit is filed. <br /><br />It should be pointed out , however, that even if doctors entangled with a lawsuit are eventually exonerated, the harshness of the experience will leave them forever questioning the noble goals of medicine and the justice of the legal system. <br /><br />But there are other reasons for defensive medicine besides the threat of malpractice suits. <br /><br />The refinement of imaging studies and lab tests and their quick turnaround time can seduce doctors into thinking that talking to patients and examining them is of secondary importance. What’s more, ordering lots of tests and consultations can give patients the false impression that their doctors are exceptionally capable and thorough. Also, the data from scans and lab tests are more objective and reproducible than that obtained by a history and physical examination. And, they may withstand better scrutiny in a malpractice action. <br /><br />Additionally, economic pressures drive doctors to order scans and tests in order to speed up diagnosis and discharge from the hospital. <br /><br />Ideally, the no-fault system that Dr. Alpert recommends has great promise. But studies published in the New England Journal of Medicine in 1991(2, 3) showed that sometimes no suits were filed even though malpractice had occurred. Thus, there is a risk that more injured parties may file claims and the system’s funds may go bankrupt or doctors’ premiums may raise to unsupportable levels. <br /><br />Clearly, the problem is a difficult one without a single or a simple answer. Perhaps, access, cost, and physician demoralization have to worsen before sufficient dissatisfaction with the system compels medical educators, insurers, and lawmakers to bring about beneficial change. <br /><br /> It is hoped that doctors will lead that change. <br /><br />-- Edward J. Volpintesta MD, Bethel, CT<br /><br />1. Alpert JS. The 800-Pound Gorilla in the Healthcare Living Room. Am J Med 2011; 124:187-188.<br /><br />2. Brennan TA, Lucian LL, Laird NM, Liesi H, Localio JD, Lawthers AG,Newhouse JP,<br />Weiler PC, Hiatt HH. Incidence of Adverse Events And Negligence In Hospitalized Patients. N Eng J Med 1991; 324:370-376.<br /><br />3.Localio AR, Lawthers AG, Brennan TA, Laird NM, Herbert LE, Peterson LM, Newhouse JP, Weiler PC, Hiatt HH. Relation between Malpractice Claims and Adverse Events Due To Negligence. N Eng J Med 1991; 325:245-251.]]></description> <content:encoded><![CDATA[<p>In his recent editorial, Dr. Joseph Alpert (1) discussed his dissatisfaction with the way the legal system deals with medical malpractice and how the threat of malpractice suits pressure doctors to order unnecessary tests so they have a good defense in case a suit is filed. </p> <p>It should be pointed out , however, that even if doctors entangled with a lawsuit are eventually exonerated, the harshness of the experience will leave them forever questioning the noble goals of medicine and the justice of the legal system. </p> <p>But there are other reasons for defensive medicine besides the threat of malpractice suits. </p> <p>The refinement of imaging studies and lab tests and their quick turnaround time can seduce doctors into thinking that talking to patients and examining them is of secondary importance. What’s more, ordering lots of tests and consultations can give patients the false impression that their doctors are exceptionally capable and thorough. Also, the data from scans and lab tests are more objective and reproducible than that obtained by a history and physical examination. And, they may withstand better scrutiny in a malpractice action. </p> <p>Additionally, economic pressures drive doctors to order scans and tests in order to speed up diagnosis and discharge from the hospital. </p> <p>Ideally, the no-fault system that Dr. Alpert recommends has great promise. But studies published in the New England Journal of Medicine in 1991(2, 3) showed that sometimes no suits were filed even though malpractice had occurred. Thus, there is a risk that more injured parties may file claims and the system’s funds may go bankrupt or doctors’ premiums may raise to unsupportable levels. </p> <p>Clearly, the problem is a difficult one without a single or a simple answer. Perhaps, access, cost, and physician demoralization have to worsen before sufficient dissatisfaction with the system compels medical educators, insurers, and lawmakers to bring about beneficial change. </p> <p> It is hoped that doctors will lead that change. </p> <p>— Edward J. Volpintesta MD, Bethel, CT</p> <p>1. Alpert JS. The 800-Pound Gorilla in the Healthcare Living Room. Am J Med 2011; 124:187-188.</p> <p>2. Brennan TA, Lucian LL, Laird NM, Liesi H, Localio JD, Lawthers AG,Newhouse JP,<br />Weiler PC, Hiatt HH. Incidence of Adverse Events And Negligence In Hospitalized Patients. N Eng J Med 1991; 324:370-376.</p> <p>3.Localio AR, Lawthers AG, Brennan TA, Laird NM, Herbert LE, Peterson LM, Newhouse JP, Weiler PC, Hiatt HH. Relation between Malpractice Claims and Adverse Events Due To Negligence. N Eng J Med 1991; 325:245-251.</p> ]]></content:encoded> </item> <item> <title> By: Martin </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-204</link> <dc:creator><![CDATA[Martin]]></dc:creator> <pubDate>Thu, 31 Mar 2011 20:45:00 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-204</guid> <description><![CDATA[Dr.Alpert's suggested approach to medical malpractice has the virtue of common sense, unfortunately rarely a guarantor of implementation. Controversy over the make-up and voting of panel members would arise, but a workable and fair system should be possible. Whether it would change unnecessary testing is less certain, for the standard of care is only what a reasonably prudent physician would do. Hence, we must first agree on what a reasonably prudent physician needs to do in a particular clinical setting.<br /><br />Martin Terplan, M.D.<br />Clinical Profesoor of Medicine,<br />University of California, San Francisco]]></description> <content:encoded><![CDATA[<p>Dr.Alpert’s suggested approach to medical malpractice has the virtue of common sense, unfortunately rarely a guarantor of implementation. Controversy over the make-up and voting of panel members would arise, but a workable and fair system should be possible. Whether it would change unnecessary testing is less certain, for the standard of care is only what a reasonably prudent physician would do. Hence, we must first agree on what a reasonably prudent physician needs to do in a particular clinical setting.</p> <p>Martin Terplan, M.D.<br />Clinical Profesoor of Medicine,<br />University of California, San Francisco</p> ]]></content:encoded> </item> <item> <title> By: Joseph Alpert </title> <link>https://amjmed.org/the-800-pound-gorilla-in-the-healthcare-living-room/comment-page-1/#comment-203</link> <dc:creator><![CDATA[Joseph Alpert]]></dc:creator> <pubDate>Wed, 30 Mar 2011 23:20:41 +0000</pubDate> <guid isPermaLink="false">http://amj.crankydeveloper.com/?p=186#comment-203</guid> <description><![CDATA[Again, I thank the additional blog communicators who responded today. It seems we are all on the same page: Hospitals want lots of tests done too so they can justify the expensive imaging equipment that they just bought. Industry is happy with the sale of all the equipment; the insurers just keep raising their rates to keep up with the costs; and the lawyers advertise on TV and billboards in order to stimulate public greed. The sick patient in this case is definitely the US healthcare system. Joseph Alpert]]></description> <content:encoded><![CDATA[<p>Again, I thank the additional blog communicators who responded today. It seems we are all on the same page: Hospitals want lots of tests done too so they can justify the expensive imaging equipment that they just bought. Industry is happy with the sale of all the equipment; the insurers just keep raising their rates to keep up with the costs; and the lawyers advertise on TV and billboards in order to stimulate public greed. The sick patient in this case is definitely the US healthcare system. Joseph Alpert</p> ]]></content:encoded> </item> </channel> </rss>