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What the public needs to know. & How it effects the public. I had originally wrote an article that I was hoping would make the editorials of a local newspaper. However, it seems that nobody really cares about the currrent malpractice crisis. Although not every state and city experience this problem, some are in dire need of help. To my knowledge Cleveland Ohio and Los Angeles California are two out of the top three cities in the country, for medical malpractice insurance costs. There are so many things to explain, and these all affect you the pateient. Private practice physicians may not be around in the future. The reason is due to rising malpractice costs. The most important thing to remember is, no physician can practice without malpractice insurance. If the said physician cannot afford to pay malpractice insurance he is left with only a few options. This is what private practice physicians are running against. 1) Retire - in which the said physician also needs to be able to afford "Tail coverage", which covers the said physician in the event a lawsuite occurs after retirement. 2) Move out of the area or state. (This seems to be the trend) 3) Find some other means of covering your medical malpractice insurance. Like a large hospital system, if the system will agree to this venture. In which case, the physicians are essentially employees of the institution. Just like anybody else, they have to do what their boss would like them to do. No independence. This is the way you should practice, and we expect you to see X number of patients a year. 4) If the physician is part of a group of physicians. That group may merge with another group. There seems to be better rates in numbers. Although this is not very commonly seen. One undisclosed physician had told me, since 1989 they had left their charges unchanged in their computer. While he did not charge these fees, the charge amounts were left in the computer system. He claimed insurance payments have decreased approxiamtely 10% a year, since 1989. Basically in short, insurance companies decide how much something is worth and that is what they will pay. Medicare and Medicaide have also decreased payouts on physician services. Just pick up any newspaper, or turn on a news channel on the radio or television. This is not new, it's been occuring for some time now. Remember these things are the primary source of income for a physician. Physicians are not allowed to charge more or less, to my knowledge they are regulated. Malpractice Insurance rates, are decided by the number lawsuites, settlements and amount of payouts they make. The more they have to pay out, the higher the rates will be increased. Insurance companies pay out, because it's cheaper than going to court for years. I am sure anybody could read in a newspaper, or hear on television about a court case that has been going on for years. Let's face it, somebody is going to have the expense passed on to them. The insurance companies are not out there doing charity work. Summary up to this point - Insurance rates go up, and income drops. How long can this continue, before somebody has to bail out? Do you have a hard time contemplating this? Here is a great example. Most people expect about a 3% raise a year. I have heard most people say, 3% does not even cover the cost of inflation. Now imagine that along with your 3% raise a year, your car insurance goes up %10 a year, and your salary will decrease 10% a year. How long could you keep this up? If you could move out of state and cut your insurance rate by 80 - 90%, and make more money, you might leave also. Practicing "Defensive Medicine" is response to the increased relevance of lawsuites. Defensive medicine is a way of practicing, to prevent a legal outcome. Here are two examples. The way it used to be: Let's say you come in to the emergency room with a cough, and congestion. The physician examines you. He determines your breath sounds are clear and there is no fever. He then decides to give you and albuterol aerosol treatment. It helps and he sends you on your way, with a prescription for and albuterol MDI. There is always a chance you could be developing pneumonia, asthma or any other lung problem. However, given the exam it's unlikely any of those will occur. So the ER physician and hospital bill you for their time and treatment, and all is fine. This has probably happened hundreds of thousands of times without incident. Then one of those hundreds of thousands patients treated, dies. The family attempts to sue the physician. It's nothing he did wrong. However, it is easier and less expensive for the malpractice insurance company to settle out of court. Defensive Medicine Treatment: Let's say you come in to the emergency room with a cough, and congestion. The physician examines you. He determines your breath sounds are clear and there is no fever. He then decides to give you and albuterol aerosol treatment. Instead of sending you home at this point, the physician decides on some other things. He does some other tests. Why? Because he cannot afford rate increase. He knows with all the right tests, it would clear him/her legally. So the physician orders a chest x-ray, a CBC with diff, chemistry, maybe arterial blood gasses, D-Dimer, and eventually a cat scan of the chest. All comes back negative. However, he/she also decides to administer a anti-biotic through the IV. The physician gives you a prescription for an antibitoc and albuterol MDI, upon discharge. Most likely the albuterol aerosol would have been enough in this case. However, it was legally neccesary to perform all the extras to avoid a lawsuite in the event of a tragedy. Who pays for this? You do, via your insurance company. Defensive medicine has become the norm, rather than the alternative. To cover the added costs, insurance companies raise your deductable, stop covering presciptions, and raise their rates. It is a huge cycle that is making the entire medical system unaffordable for both patients, and physicians. Something needs to be done to control the increasing rise of medical malpractice lawsuites. Whether it is tort reform, jury education on pathology, different jury selection or another way of evaluating the legitamacy of these suites. Currently, the plaintiff has nothing to loose. The defendant in these cases will have to pay, whether they are guilty or innocent. That is just horrifying. Many attorneys will pick a case up for a percentage of the settlement, just for this reason. Most times a malpractice company will settle. It's by far cheaper than dragging something out in court for years. Do you like your doctor? Do you think he is wonderful? He may not be around much longer. We are all responsible for fixing this thing. The private practice physician is doomed to extinction, if something is not done. Those physicians with experience will, leave the area, retire or even find another career, leaving our health in the hands of the less experienced. If you do not beleive it, beleive it! It happened to me. My own personal doctor left the state along with 15 other physicians over a 16 month period, because of these issues. I have also worked with him. He was clearly an amazing and gifted physician. The area has lost one of its best, and many others. In memory of.................................................  We need to break the mentality of I'll go get a pill from the doctor, and everything will get better. Doctors help the body heal or take care of itself. The rest is up to you. Don't be an uneducated patient, know what you have and how to help yourself. We all need to take some self accountability, and stop blaming others. PLEASE READ THE BELOW STATEMENT CAREFULLY BEFORE LEAVING THIS PAGE This page contains articles on medical topics; however no warranty whatsoever is made that any of the articles are completely accurate. There is absolutely no assurance that any statement contained on the web page touching on medical matters is true, correct or precise. The article is written, in part or in whole, by nonprofessionals. Even if a statement made about medicine is accurate, it may not apply to you or your symptoms. The medical information provided here, is at best, of a general nature and cannot substitute for the advice of a medical professional (for instance, a qualified doctor/physician, nurse, pharmacist/chemist, and so on). I do not take any responsibility for the results or consequences of any attempt to use or adopt any of the information presented on this web site. 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