Sunday, February 17, 2013

Liability Reform: It's Coming

A collision is coming.

Scratch that.

The collision is here.

I'm not quite sure how to describe this, but I'll try.

Every day, I look at a computer screen for health care delivery with an increasing number of menu options.  I tried counting these menu options once and after scrolling through them, I never reached all of them after counting up to 275 items.

Yes, there are more than that, but suffice it to say, for most of us, that's enough to make my point.

Next, are the data points that confront my eyes every day.  Data points from all over and from all sorts of people.  Some whose names I recognize (even a few from me), but more importantly, many of whom I don't.  Hundreds and hundreds and hundreds of data points, streaming to me every single day.

What are these interrupters?

Many are orders for procedures.

Others are for results.

And phone calls.

And messages.

And patients recently admitted to other services for other procedures just so I know about them.

And patients to be scheduled for a procedure at a later date.

And blood draws.

And EKGs that have been ordered and not "signed."

And EKGs that have been read and not "signed."

And EKG results that were "signed" but returned to my "results" box just to remind me I "signed" them.

And ... well, just about anything.

All as part of the Great Medical Health Care Team plan.

But wait, who ordered all of these procedures, tests, results to be sent my way?

Some I did, but far more often, other people did.

Those other people are people who have been ordained capable of ordering those tests by other people.  Other people in our big, burgeoning health care system that extends over a larger an larger geographic area with more and more doctors than ever before.

And herein lies the challenge and the best hope for doctors' liability reform going forward: diffusion of their responsibility.

A few central planners whose grandiose health care narcissism have allowed unfettered access to physician responsibility for health care actions outside our real control in our new health care model so they can be paid.  Perhaps this was inevitable given the priority of providing care of so many more people without increasing doctors' ranks.    But as a result, doctors have unwittingly permitted programmers to send us all of these "notifications" so we must click on them so we can assume responsibility for their presence.  It's all part of the game:  get the doctor to click on it so it can be billed to payers.   Get the doctor to click on it so he or she can take the heat if there's a problem.

Licensed medical doctors continue to allow click after click after click, not to show we are using a computer "meaningfully" (as the programmers and political wonks would like you to believe), but really so we can assume responsibility for the results that ultimately come our way and for others to bill.

Need a flu shot?  Don't worry, it's auto-programmed computerized care pathway programmed by others on behalf of patients everywhere will happily send us a notification that the test was ordered and the results sent to the doctor so he or she can assume responsibility before he or she is even aware the test was ordered and resulted.  There it is: silently lying there in their inbox.

Click, doctor, click.

Forget about the egg allergy?  Oops.

Sorry, doc.

But increasingly, there's a little something that's happening as patients assume more of their health care bill: doctors are finding that they are effectively "responsible," even though we have no idea what things cost.  We are "responsible" for the patient's tests ordered, even though we didn't order them.  We are responsible for the results, because they come our way.  We are responsible for our "team," even though we had no responsibility for its selection.

The fanciful dream that doctors can be responsible for problems that arise can be completely blamed on doctors is a joke.  A very, very bad joke.

This is why liability reform will happen, whether the lawyers like it or not....

... not because doctors want it (even though they do), but because Big Business does.



Anonymous said...

One could have made and will make a lot of money going long CERN;range=5y

Too bad that there can't be a stock ticker which represents physician's stock price. That would be a great one to 'short' or buy puts. Oddly, it would be the inverse of CERN.

Wes, you forgot to mention that the computer tracks how long you look at messages, review orders, take to read an echo, etc, etc. Just wait until the lawyer asks you why you only looked at the warning for .5sec. Luckily, this will not interfere with the appreciation of CERN stock price.

betsy said...

Though I am certain to elicit another ad hominem attack by other readers of yours who worship at the altars of change and "patient empowerment", I would like to ask if you will also be liable for every home EKG some hypochondriac beams you from his phone at all hours.