Practice Makes Imperfect

How real is the medical malpractice myth?

Ezra Klein’s diagnosis on “the medical malpractice myth” and positive evaluation of a reform proposal by Sens. Hillary Clinton and Barack Obama brought medical professionals, public policy analysts, and consumer advocates all out of the woodwork. 

courtgrunt, a civil-court clerk, scrolls through his county’s database of pending cases and finds four medical malpractice suits (out of a random sample of 500), leading him to conclude “there aren’t even close to as many medical malpractice lawsuits filed as the media (or extreme right wingers) would like us to believe.”

By contrast, claiming that Slate “slants the whole issue as if malpractice were as mythological as unicorns,” MomboMan-3 lists a series of points underscoring the very real problem facing doctors today.

Luchese laments that patients are now numbers:

In over two decades of Obstetrics I found that communication with the patient not only humane and professional but allayed questions and concerns about treatment and outcome. Most physicians do not communicate with their patients and hence suffer lawsuits because of feelings of abandonment or subterfuge on the part of the patient. The profession is now driven by technology, money and productivity. Patients are no longer people but numbers. Furthermore the burden to healthcare now and will be those illnesses and diseases caused by lifestyle; obesity, high blood pressure, high cholesterol, diabetes, smoking, and those resulting from society; stress, depression, anxiety, insomnia. All the technology, training and malpractice insurance cannot change this.

But antsi, an obstetrician “for almost ten years,” attests to having “seen the pernicious effects of malpractice litigation first hand. Reading this article, I feel like a swimmer being told by someone standing on dry land that the water isn’t wet.” Read his objections here.

An indignant ShanCan blasts the lack of transparency in the medical profession:

Why is it that any Taco Bell has to be regularly inspected, get a letter grade, and have it posted for all the world to see but it is virtually impossible for me to find out the safety record of the cardiac surgeon who is going to slice me open and literally hold my heart in his hands? Why is it that I can lose my driver’s license after a series of violations in which no one is harmed, but a physician can keep his medical license regardless of how many deaths s/he contributes to simply by paying a higher insurance premium, so long as the errors are deemed to be accidental and not negligent? Why is it legal for a doctor or hospital to cover up their lethal mistakes with a pile of money and a confidentiality clause? It is not a secret to anyone who actually reads the literature that the problem is not a rash of frivolous lawsuits but a rash of dangerous doctors and hospitals with no real accountability beyond their own consciences. Kudos to Clinton and anyone else who proposes an idea that may solve a legitimate problem in a way that benefits the public rather than a small interest group like - but good luck getting something so practical and potentially effective through the legislative process.

rcf broadens the debate on medical malpractice costs to include all the players: “Realize doctors are not the only medical providers who make errors. Nurses do, clerks do, aides do, lab techs do, PA’s do. Such an error no matter who makes it can lead to a cascade of subsequent errors.” Read his reform proposal here.

For Dayenu, the point of medical malpractice cases is “to make patients (or their survivors) whole again. They are not designed to improve health care. In fact, in some ways they fail to do just that, by convincing policymakers that a lawsuit solves the problem for the next patient, when it doesn’t. In the first place, the problem isn’t just paying claims, it’s the cost of medical malpractice insurance. In the second place, is there any proof that malpractice cases do anything to improve health care to individual patients or even stop individual bad doctors from practicing medicine?”

michaeltwatson, author of America’s Tunnel Vision—How Insurance Companies’ Propaganda Is Corrupting Medicine and Law, writes in to make a plug for his book and deplore the prevalence of medical error.

You can add your two cents in Medical Examiner. AC7:30pm PDT

Tuesday, July 11, 2006

There exists in our society a widespread fear of judging that has nothing whatever to do with the biblical “Judge not, that ye be not judged,” and if this fear speaks in terms of “casting the first stone,” it takes this word in vain. — Hannah Arendt, Responsibility and Judgment

If there are actual themes to the weekly discussions taking place in our Fray, last week’s would surely have been “who’s to judge?” Stephen Metcalf’s iconoclastic assessment of John Ford’s The Searchers was blasted with a fusillade of canon ire by outraged film lovers in our Dilettante Fray.

By volume, the most common sentiment appears to be the mind-poppingly contradictory belief that nothing but criticism merits critique: “People who’s job is to criticize other peoples work don’t have much going for them in the first place. In other words Stephen, GET A LIFE!!!”

Other posters seem to believe that the best critic is little more than a mirror at the end of a dimly lit hall, reflecting the image of what the reader will eventually experience: “A critic’s job is to look at whether or not the general audience will enjoy a movie and offer their opinion on THAT.”

To those with high hopes for a demotic literary culture, the experience of reading every thread in the Fray may call to mind Heidi Julavits’ assessment of contemporary criticism from The Believer’s inaugural issue: “Reading many reviews these days, I have the feeling of dust settling on a razed landscape, in which nothing is growing, in which nothing can grow. And this is what makes me depressed, and then angry, and then invigorated by the possibilities that every wasteland suggests.”

But flowers already bloom, even in this Philistine desert. Most notable are lucabrasi’s excursus on Vertigo, jumblejim’s passionate plea on behalf of the untutored aesthetic, and NickCharlesivory-tower rebuttal. For a condensed display of other good points and good discussions, you can view the Editor’s Picks. (Newbie users may wish to click here to restore regular Fray-vision.)

Over in the Movie Fray, angry Fraysters are fit to keelhaul Dana Stevens for her movie review of Pirates of the Caribbean: Dead Man’s Chest.In the course of panning the film, Stevens confesses to her readers that “the movie depends heavily on in-jokes and references from the previous installment—a movie I always meant to see” but never did. The consensus opinion (perhaps a first on the Fray) is best expressed by bob_mong:

How can a movie critic be too busy and/or apathetic to see one of the top five grossing films of 2003, a film that was nominated for five Oscars? What was especially amusing/appalling was how she tries to justify that apathy for her profession:

Dropping in on the middle chapter of a trilogy seems as good a way as any of assessing the state of the franchise.

Actually, no, it doesn’t seem that way. Rather, it seems like as lazy a way as any of assessing the state of the franchise.

Should a preference for the subject under review be part of a critic’s job requirements? Dancing_Otter,a self-professed sci-fi writer,takes her standards to the next level:

It’s all too common for “mainstream” reviewers to heap disdain on a genre they clearly neither appreciate nor understand. I mean really, would anyone dare to start a serious review of –say, wine– with: “I don’t drink wine, but man this red stuff really tastes weird to me.”

Last week’s Dear Prudence column presented a tinderbox of domestic drama—a weeping bastard child, philandering mother, dithering father of doubtful status, and an inscrutable stepmom-to-be. Into this incendiary mix, the New Prudie casts a hot judgment against the letter writer:

Perhaps you see an opening to eliminate an uncomfortable situation from your new marriage and get David and his mother out of your life. Drop it, encourage Ken’s relationship with his son, and embrace the boy.

In response, switters erupts, “Goddammit, Prude, there are people hurting out there!”

No, Prudie, it’s not a big deal, except when you consider that if David’s mother decides to get a paternity test and it’s discovered he’s not Ken’s son, David is ripped away from him like an aborted fetus. […] The dude’s terrified that his son may technically, legally and biologically not be his and all of the various ramifications such knowledge would inevitably bring about. […]

You’re reading into her letter some sort of underlying motive of getting “David and his mother out of your life.” Oh sure, you’re free to apply whatever hermeneutical interpretive devices you care to upon your letters. But immediately portraying her as an evil step-mother crosses the line when there’s so little evidence to back it up. […] God forbid she’s actually looking for some constructive advice on how to help her future husband protect himself from unpleasantness.

So, who’s to judge? Why not you? Just bring your own stonesGA3:00pm PDT

Friday, July 7, 2006

Motivated in part by his own affliction from Parkinson’s disease, Michael Kinsley’s piece on “what pro-lifers are missing in the stem-cell debate” elicited a passionate response in Read Me.

Rejecting Kinsley’s straw man argument “that all or most opponents of such harvesting equate a microscopic embryo to an adult human life,” RoboTombo instead draws a moral line “between producing embryos with the intent of destroying them (stem-cell research) and producing embroyos with the intent of producing a human life (fertility clinics).”

TheRanger notes a contradiction in Kinsley’s “attempt to dehumanize the embryo. He vainly tries to couple sentience to the beginning of life while at the same time claiming that nobody can define when life begins.” For skruuball, “those who oppose stem-cell research on the basis that life begins at conception” while praising the work of fertility clinics are the ones guilty of inconsistency, “as the number of embryos destroyed during the in-vitro process dwarfs the number that would be destroyed during the harvesting of stem cells. However, coming out against fertility treatments is not nearly as politically expedient.”

In her opposition to the destruction of all embryos (even for ostensibly good causes), MaryMack3897 makes this broader claim: “Pro-choice proponents are really pro-self proponents. They do not endorse the practice of letting everyone make choices for themselves, because they support practices such as abortion, which prevent the formation of free-will from ever occuring.”

Xando places “the burden of proof on supporters to prove that stem cell research is a valuable use of government funds.” Criticizing the practical effect of such a position, lucymom contends that “blocking government funding … will stop many of the best scientists from doing this research. It is very difficult to conduct high level science with private funds for many reasons. Stopping public funds is a way to reduce the amount of research done and the opponents know it.” engineer counters:

…if there is really a big payoff, wouldn’t the private sector be investing in this as a cure for Parkinson’s, nerve damage, etc.? I imagine Mr. Kinsley and other sufferers would gladly pay for a cure.Stem cell science is at the basic stage and does not justify spending much public money. We lose many more people to heart disease, traffic accidents, drug addiction and mistakes in hospitals. Those areas are not very sexy, but have a large impact on public health.

The stem cell issue may end up like breast cancer, but with its own color ribbon. Lots of money will be spent with little reduction in the leading causes of death and sickness.

Speaking of public funds for stem-cell research, you can find out the latest on California’s Institute of Regenerative Medicine (funded by voter-approved Prop. 71 in Nov. 2004) here. AC11:47am PDT