Disclosure and Resolution Program won’t prevent Physicians from Practicing Defensive Medicine

Originally published by Illumination Curated on Medium

Photo by National Cancer Institute on Unsplash

Healthcare is expensive. Running a medical practice embraces high overhead and concomitantly contributes to the ever-rising medico-legal expenses. The damage is universal for every medical practice, irrespective of the size and the specialty. According to a benchmark, a single physician practice nowadays with, let’s say, $50,000 of monthly revenue (which would roughly entail $76,000 in charges minus adjustments and write-offs) should expect an overhead of around $30,000.

The average physician malpractice Insurance cost remains everywhere from $7,500 to $50,000 annually. Every physician practice would pay between $4,000 and 12,000 a year in addition to the following charge. Becoming a physician entails lifetime investment, including punitive and fiscal burdens that a person must withstand to become a physician. Therefore, being disputed is a significant expense to endure and, if not prevented, can partake devastating consequences for the clinician.

Over 17,000 malpractice lawsuits are filed in the United States annually. According to the Medical Scribe Journal, the average U.S. physician faces malpractice suits once every seven years. If a lawsuit is filed, the cost practitioners pay extends beyond just financial harm, including reputation and emotional burden.

In a seamless scenario, the medical practice realm would ideally comprise the independent and exclusive doctor-patient relationship. And only then would one swiftly appropriate the malpractice as the real upshot of a treating physician’s ineptitude to establish a proper relationship with their patient or considered professional negligence. Nevertheless, the concluding scenario, as we speak, is far from reality. These days, the medical practice is far-off from being personal, transparent, or even ideal.

Defensive Medicine is the sign of Physician Insecurity.

The physicians of the 21-st century are bound to never-ending legislative mandates, guidelines, and artificial business ordains. Modern healthcare is, more than ever, corporate-ridden and utterly overhauled by bureaucracy. More so, physicians, patients are hard-pressed aside while insurance and pharmaceutical firms are occupying the driver seat of the “fast train,” headed towards the cliff's edge. As a result, Physicians facing the hurdle of alienation and loss of autonomy remain to overcome the obstacle and stay ahead of the game. On the other hand, they must, in tandem, balance the risk against the benefits of clinical decision-making. Frequently, among many strategies, at some point in time, physicians, too, may act defensively.

Defensive medicine or defensive medical decision-making is the practice in which physicians adapt to shield themselves from legal ramifications initiated by patients. It primarily applies to recommend a diagnostic test or medical treatment that is not fundamentally the fittest option for the patient.

Defensive medicine provides an alternative that principally serves the function of protecting the physician against lawsuits. The average annual defensive Medicine cost by those mentioned above, according to One Study, is $46 Billion.

Healthcare Costs due to Malpractice

According to a publication in Forbes magazine, the rate of medical malpractice in the United States surpasses $55.6 billion a year, $45.6 billion. Part of the latter type is the upshot of wasteful defensive medical practices, merely comprising 2.4% of the nation’s total health care expenditure.

Disclosure, Apology, and Offer Programs

Amid numerous attempts and theories to reduce defensive medicine and medico-legal expenses, few scholars have proposed the concept of disclosure, apology offer program.

Because, in the current healthcare administration system, many patients injured by physician fault never learn about that particular slipup. Physicians have traditionally shied away from talking about their “errors” with patients. The latter remains partly fearing to step up a malpractice lawsuit, and somewhat because of the embarrassment and uneasiness associated with the confession. Even so, based on a few surveys, most physicians feel that such disclosure is reasonable.

The revelation of all harmful errors classically includes explaining why the mistake occurred, How to curtail the error’s consequences, and what steps the physician and organization are willing to take to prevent future relapses. Full disclosure also contains an acknowledgment of accountability and an act of contrition by the physician.

The idea is that the form of Disclosure-And-Resolution Programs that incorporate reasonable reimbursement proposals may be swift a complex patient retort.

According to a publication in health affairs, early adopters of the latter approach have reported reduced liability costs. Still, the extent to which these fallouts stem from fair disclosure and apology practices and how it plays towards the value of compensation is blurred.

Although suppositions defer to that patients have the disposition to welcome the routine inclusion of compensation offers in the disclosure process, up till now, patients’ rejoinders to compensation proposals are more intricate than one can do.

More copious proposals don’t inevitably bestow advantages in preventing patients from seeking legal counsel. It neither promises to maintain trust and reliable, satisfying relationships. Thus, arguably separation between disclosure conversations and compensation offers may aid in avoiding perceptions that both disclosures and offers are merely strategic behaviors rather than moral deeds and signs of goodwill.

Why do Patients file Lawsuits?

Just as to why physicians elect defensive medical behavior, patients also reflect taking legal action when they perceive inexcusable and erroneous exercise from their treating doctor. It is comparably effective to state that the trigger of why and how patients decide to litigate is beyond a forthright blunder on behalf of the clinician. It is the estimation; over 50% of malpractices unfluctuating don’t end up in litigation.

Every jurisdiction has its particular laws that outline what defines medical malpractice or deviation from the standard of medical practice. However, the generally accepted criteria for malpractice lawsuit is:

The first and the most crucial prerequisite is that there must be a direct doctor-patient relationship through in-person face-to-face interaction with or without bursting verbal and or written consent established between the two parties.

Second, there must be direct medical care rendered to the patient within the context of the close relationship.

Third; The treatment provided by the physician must have caused apparent damage to the patient.

Fourth, the triggered damage results from the deviation from the “standard of medical care” commonly practiced by the mainstream of peers in the current time and medical community.

In the United States, 1 in 3 Physicians faces Lawsuit

According to a report published by the American Medical Association (AMA), over 35% of physicians end up with medical liability lawsuits at some point in their professional lives. The chance of facing legal action surges parallel to the length of a physician’s practice length. According to a report, approximately half of the physicians over 55 years of age have conveyed having been litigated.

The probability of being sued by a patient on the face of it was suggestively lower for doctors younger than 40 years of age (8%) and female physicians. The attributable factors, such as age and specialty, also played a role in the case of female physicians.

According to another report, we need to keep in mind that for the vast majority of claims, the patient claimants do not prevail, as 68% end up being dismissed, dropped, or withdrawn. However, any claims notwithstanding the result still levied more than $30,000 in defense costs.

The typical profile of Patients thinking of Litigation

Every patient has a different reason why they decide to take legal action following a medical error. A study published in NCBI by Hippokratia outlines some of the probable roots. The study exhibited 21.5% of the discrepancy relating to the reasons behind legal actions. Younger age, weaker relationship with religion, making fewer than 15 visits annually to any physician, outpatient status, and higher expectations for access of the medical information revealed to be linked with the higher likelihood to consider taking legal action against their physician.

Besides, Patients’ longing to disclose a medical error (82.2%) exceeded their expectations for financial compensation, particularly in less severe cases (24.1%).

The study finds that valuing patients’ demand for their information during clinical visits and continuing exposé of the medical errors when they transpire appears to be the more patient-centered strategy and the furthermost unswerving way to reduce the plausibility of a claim.

What is the problem with the Disclosure and Resolution Program?

There is an ocean of studies and suggestions to reduce unnecessary medico-legal actions by patients, defensive medical practice on behalf of physicians, and reduce healthcare costs as the upshot of the asynchrony between all the above. Moreover, most, if not all, solutions reference personalization by using buzzwords such as transparency, patient information, and personal disclosure and resolution. Then, it gives the impression that every solution offered has been blind-sighted by the wrong course of action besides tunnel vision.

Almost every solution is converging on cost reduction short of addressing the root of the problem, which brands healthcare, particularly “de-personalized.”

Some may argue that the current system is moving towards personalization, and personalization of the medical practice is not sufficient to reduce medico-legal costs. In the discontentment to the latter, I must say; the current definition of personalized healthcare has been the subject of erroneous semantic shift. For that reason, In the following sections, I intend to expand on this thought.

Societal Engineering and Semantics of Personalized Healthcare

Social engineering, a particular discipline within social science, has often been utilized to influence attitudes and behaviors of communities on a large scale. Governments, media, or private groups always use societal engineering and intentional semantic change to produce desired characteristics in a target population. In a philosophical sense, social engineering is a detrimental phenomenon pointing to the intentions and goals of the new societal architects.

The medical domain, most explicitly personalized healthcare, is not extra-terrestrial to the latter concept. For example, idioms like; Personalized medicine, quality care, value reimbursement, health, and healthcare in the current healthcare sphere represent a few of the many buzzwords filling the industry headlines. Their definition is in the context of the few stakeholders and players’ words.

Or, The Value of Healthcare today describes partial measures beyond the personal realm. Today, political rhetoric provisions the current value of medical service as the output of the baseless third-party set of rules. Their rhetoric is just about a buzzword to entice interest without providing any substantial Value. Quality, as the driver of the value, in healthcare today, is being conveyed as a mathematically driven figure.

Let’s start by giving the Medical Record to the Patients

A knowledgeable, professional, and empathic physician and an honest; also sincere patient sharing a well-orchestrated doctor-patient relationship should include full access to any known records that exist amongst them with full ownership of healthcare data. Any deviation from this will prime deprived clinical conclusions then skepticism about sharing any information.

The recorded health information portrays the significant story of doctor-patient interaction. The value and helpfulness will increase as we make it further comprehensive, clearing all errors and misinterpretations.

I soundly gather; any medical record or health data is the property of its narrator. Health information is the artifact of personal collaboration between one patient and one doctor. Any information, accordingly, should be under their tenure. The medical data should be shared based on the contribution between the two people. If treasured, this will improve the trust and remove any slanting while strengthening the doctor-patient bond. Poor communication is the grounds for patient dissatisfaction, hence legal complications.

Some doctors shoulder that giving full admittance to health records will sooner or later accelerate brand-new inquests from the patient, overlooking the fact that everything in the document was already discussed with the patient during their encounter.

Considering that full disclosure of documented clinical judgment or data may be offensive to patients is not a valid argument since any clinical diagnosis, offensive or not, must always be unveiled to the patient. Withholding any information must be reputed as a deviation from medical practice standards.

Groups of physicians argued based on the dread, patients may take clinical notes out of milieu and restructure the meager version or translations of an otherwise accurate clinical judgment. It is not necessarily about paraphrasing into layperson terms as it concerns the ability and flexibility to share necessary information without running into hurdles of bureaucracy and lavish expensive procedures.

Some believe that it can change the doctor-patient relationship. Still, I, for one, think it would only head in the positive direction by growing trust and transparency between patient and physician.

Few also sustain that if the patients don’t like the clinical instruction, they can go elsewhere- I say- a patient has the right to pursue a second opinion. The latter remains highly improbable if everything is discussed in advance with the patient under full transparency.

Others have steered to the idea that sharing full medical records would involve patients researching their ailments and comparing them with the notes shaping compliance issues. But then again, the concluding scenario can lone transpire if the doctor and patient relationship are in disarray. Regardless, Patients will perpetually investigate their problems, with or without owning their medical data. Then, withholding records can only lead to a rash judgment by the patient because they failed to receive the enlightenment that would otherwise be accessible from their notes.

The Millennial Demand Personalized Healthcare

It is the inevitable trend that millennials want to take their healthcare into their own hands. They want to be part of the decision-making process and demand to be the ultimate decision-maker of what personally makes more sense to them.

Millennials prefer the healthcare system to appreciate that patients see to the due diligence of their symptoms before visiting their doctor. They expect transparency and up-front cost estimates for the clinic appointments and medical services rendered to them. The younger age also favors whatever is accessible by the computer or smartphone. They have confidence in technology serving as the primary gadget to colligate with the world- that comprises medical care.

For millennials being healthy has an eccentric characterization. Simply not being sick is not adequate any longer; henceforth, they demand the best and what’s unsurpassed fit for their lifestyle.

The growing generation of patients gives the impression to handle healthcare with a consumer stance like any other article of trade. The next take is shopping for health Insurance, or physician services, etc.

Consumerism is a phenomenon not newfangled within U.S. citizens; even so, it has gained unprecedented popularity in countries worldwide, even amid those where for centuries, utilitarian population health has had its way.

Patient Engagement is not Personalized Healthcare

Patient engagement is among many slogans in today’s healthcare showground. It is perpetuated as patient empowerment, thus, personalization. In other words, Patient engagement is primarily descriptive of everything from patient portals to social media strategies or from tracking vitals with wearables to patients actively participating in their health and wellness. Then again, no one has reached a consensus as to what personalized healthcare and patient engagement are.

Before one can clutch the true definition of patient engagement, a person must foremost recognize the individuality of the doctor-patient relationship; only after the aforementioned defines the commitment of every individual in that care. Patient engagement is nothing more than involving a person in their medical care, irrespective of the technology, strategy, and means. It must also concomitantly accompany physicians, healthcare stakeholder engagement. Once every participant to the attention of one patient is independently engaged in a given stretch and place, only at that point, personalized healthcare modus is reputable.

Patient engagement without the independent collaboration of stakeholders of the particular care represents a dictation of the attention, not the “engagement.” Henceforward, Poor patient engagement will undermine the doctor-patient oath eventually will fail to break the vicious circle of defensive medicine and litigation.

Physician and Patient Independence are the cornerstones of the disclosure and Resolution Program.

The idea of disclosure, apology and resolution is the virtue of any conflict resolution between two individuals. For it is transparent, honest, and, most of all, is near accepting the responsibility of both parties’ actions based on their title role. However, acknowledging the value of the disclosure resolution without founding sway will fail to yield what it is designed to deliver, particularly regarding patient care. Envision a physician rendering a treatment uttered by insurance companies or declined repayment by the same carrier contrary to the expectation of the patient and doctor’s sound clinical judgment!

Indeed, the 3rd party meddling in doctor-patient interaction would mean that a physician must unconditionally agree to take responsibility for the insurance industry’s business-driven initiative, which may potentially translate into the cause for malpractice lawsuit for the physician. For example, the physician cannot justify the outcome by maintaining that they could not deliver the correct care because the insurance carrier declined to make available coverage for the mutually agreed plan of care with the patient.

Without personalization and personal autonomy, then disclosure, apology, and resolution program would work poorly in due course. But the end should never avert its utility under different circumstances.

Healthcare Technology Validation is Personal to Physician and Patients

The doctor-patient relationship has been for the past few decades. Of the foremost reasons for the alienation of the held relationship stands the failure of the medical community, particularly doctors, to confer on the way to changes, pre-eminent amid technological developments—the revolutionary technologies which have blended themselves with the healthcare industry. A few examples to mention are artificial intelligence, robotics, sensors, the Internet of Things, 3D printing, material science, big data and analytics, real-time social networking, and the increasing number of apps giving an upsurge to large data clouds.

The contemporary healthcare IT technology sphere has dismayed physicians so that they are inept in trusting the conventionality. The confusion is partly due to the lack of transparency and the failure to conform to offered technologies resourcefully. The newer innovations have utterly flunked to show functionality in line with the predominant standard of care.

To better accommodate personalized healthcare, disclosure, and resolution programs, physicians must enhance their understanding of the essential technologies and refine them to understand constantly evolving HITEC. The skill of the doctors has to be harmonized and directed in the path of creating and validating the kind of tools that will ultimately help them maintain the ownership of their domain; Healthcare technology.

Mutual Accountability rests on the shared active Physician-Patient Responsibility

Disclosure, apology, and resolution are personal. It necessitates the personalization of medical practice. Liability is obligatory, while transparency is the virtue of personalized medicine. Therefore, the core element of lowering malpractice action and or defensive medicine rests at the center of the impartial implementation of transparency.

We can only convey transparency by warranting it end to end along the progression ladder from start to finish utilizing the trial audit. Unfortunately, transparency is one peculiarity of which healthcare is lagging in arrears. But inevitably, yet in tandem, accountability is being pushed to the limits, forcing patients to become disgruntled and physicians apprehensive. Stunned responsibility in the face of deprived transparency equals patient distrust and physician defensive medicine.

Decentralization is necessary for optimal Healthcare Personalization

Personalization, as we spoke of, is indispensable for executing disclosure and resolution. But it will be further hindered through the rigid submission of centralization. The latter pertains to data storage, information processing, or actual healthcare logistics and operations. As medicine is the science of indefinite variations, and no two persons, scenarios, or clinical decisions are at all times equivalent. Centralization is the top-down management, as it may be convenient and flat efficient, but hardly flexible to accommodate the individual doctor-patient events.

Decentralization provides the opportunity for patients and physicians to build their particular scheme without 3rd party influence or rigid authoritarian guidelines.

Collaboration is a Personal Responsibility

One of the inert paramount gears of the human subconscious is the perception of unity or consolidation. Despite sounding common and empowering, as promising as it may seem, it isn’t necessarily the same case at the practical embodiment.

In contrast to consolidation, collaboration involves using every single talent that a person brings to the table. Collaborative effort conveys unbounded capability short of jeopardizing the advantages of the other affiliates. Nevertheless, to do well involves particular commitment, respect, and transparency to the missions and others.

The collaborative environment is a personal one. For instance, the whole medical professionals can take care of the same patient by building a personal relationship without influence from others within the network or outside the chain of patient care. The once established collaboration will further mature a healthy environment for personalization, reduce dishonest legal claims, defensive medicine, hereafter, healthcare overhead costs.

Limit on Protocols by Personalization

It is the universal nature of every human being to develop raving tasks by creating standards for the processes they are accountable for. The creation of rules or procedures demonstrates the actions or things anticipated to simplify people’s day-to-day wishes. Today the concept of standardization is transpiring within thousands of institutions to countless contexts, from technology such as international manufacturing standards to medical practices under the so-called “standard of medical care.”

Although a certain degree of standardization is always justified, the biggest argument is not necessarily why we need a routine guideline but how essential it is to defend the necessity of standard protocols and procedures without appealing friction of conflict of interest.

Every standard is restricted by a unique point of reference that attends as a recognized fixed tangible or intangible theme of coordination or leniency. Any deviation from the allusion would measure quality, efficiency, or acceptability away from the authorized insignia.

The extreme application of the clear-cut standard is the grounds for prejudicial profiling, segregation, and bureaucracy. It would, in effect, dictate any act by the benefit of overriding the variations through the conception of standard operating procedures (SOP) and guidelines. SOP is merely the function of a solo or collective deed based on famous division.

The extreme reliance on the rigid guidelines, especially those formed by 3rd party non-medical, demoralizes the doctor-patient relationship, personalization of healthcare delivery. It thus expectedly negatively affects defensive medicine predicaments.

Disclosure and Resolution Program may help but not enough to prevent Defensive Medicine

The disclosure of errors and enlightenment as to why a physician committed a fault; and how the error’s effects will be curtailed to avoid future recurrences are logical steps assumed the fairness of the system within which the error has occurred. Naturally, malpractice can occur even under the perfect scenario; however, applying the right remedy would have a much better outcome if enacted in a personalized atmosphere.

To the emphasis, the full disclosure comprises acknowledgment of duty. An apology by the physician is not once counterproductive, as everyone with a sound mind comprehends that doctors are humans and not inherently negligent. Nevertheless, both patients and the physician need to be in control of their interface.

Defensive medicine, increasing patient litigiousness are the symptom of an incapacitating disease that has infested the healthcare system, the ailment that has been eternally crippling to medical service logistics. Pending implementation of a genuinely personalized healthcare system, we will not be able to efficiently address ever-increasing healthcare expenditure, physician burnout, and patient distrust. More so, corporatization, standardization, top-down solution, alongside arm-twisting legislative mandates, one on top of another, will continue captivating healthcare in a different course.

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