"litigious" nature of obgyn

[burlypie]

So maybe it's actualy the people who are litigious toward their obgyns...but I digress.

I'm a third year, always interested in obgyn, and loving my rotation. It's the first time I actualy want to study! anyway, my friend told me that her sister, who is an obgyn, made her swear never to go into the specialty because people are too happy to throw a lawsuit their way. How do you all feel about this? Should it be a consideration in career planning? Does it give YOU pause?

I'd appreciate any thoughts

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[allendo]

So maybe it's actualy the people who are litigious toward their obgyns...but I digress.

I'm a third year, always interested in obgyn, and loving my rotation. It's the first time I actualy want to study! anyway, my friend told me that her sister, who is an obgyn, made her swear never to go into the specialty because people are too happy to throw a lawsuit their way. How do you all feel about this? Should it be a consideration in career planning? Does it give YOU pause?

I'd appreciate any thoughts

A Obgyn in my hometown in Pa recently gave up his practice b/c he was only bringing home 60k a year after malpractice and overhead. He was a good doc, but the state is very litigious. I'm also interested in the field, but very hesitant b/c of the environment.

 

[grayce79]

Yeah, I never thought I would say this so early on in my training, but I regret my choice. I am only an intern and I may already be getting sued. Williams obstetrics states that over 75% of ob/gyns have been sued at least once. It is a frustrating and stressful field. These kinds of things suck the joy out of being a doctor.

 

[3dtp]

Yeah, I never thought I would say this so early on in my training, but I regret my choice. I am only an intern and I may already be getting sued. Williams obstetrics states that over 75% of ob/gyns have been sued at least once. It is a frustrating and stressful field. These kinds of things suck the joy out of being a doctor.

Absolutely true. I almost walked out of residency the day I got named as an intern in a frivolous case. I stuck it out, and am glad I did, but no more OB for me.

 

[Jiminy Cricket]

Absolutely true. I almost walked out of residency the day I got named as an intern in a frivolous case. I stuck it out, and am glad I did, but no more OB for me.

ok, so i guess i'm not going into ob...

 

[Jiminy Cricket]

i hate it when i hear those dumb commercials that tell you to sue your ob doctor because your 14 year old son sticks his thumb up his ass every five minutes.

these lawyers are getting ridiculous.

i think ob's should put on a national strike until the max they can be sued for is 100k and insurance goes down. sure it might take a few weeks, but maybe society will appreciate the importance of obstetricians and laws will change in the favor of ob's.

 

[WhoisJohnGalt]

i hate it when i hear those dumb commercials that tell you to sue your ob doctor because your 14 year old son sticks his thumb up his ass every five minutes.

these lawyers are getting ridiculous.

i think ob's should put on a national strike until the max they can be sued for is 100k and insurance goes down. sure it might take a few weeks, but maybe society will appreciate the importance of obstetricians and laws will change in the favor of ob's.

While it would probably work, I don't think docs are allowed to go on strike. Something about the Hippocratic Oath, I think. Of course, the anesthesiologists could just stop giving epidurals to OB patients, and that might get some attention without jeopardizing care... but I don't know that they're that dedicated to the OB cause

 

[RuralMedicine]

A Obgyn in my hometown in Pa recently gave up his practice b/c he was only bringing home 60k a year after malpractice and overhead. He was a good doc, but the state is very litigious. I'm also interested in the field, but very hesitant b/c of the environment.

Unfortunately this is a very real problem. It was definitely at least 50% of the issue that led to our prior OB leaving the community. He now is employed by an FQHC so his malpractice is covered under federal tort.

 

[allendo]

While it would probably work, I don't think docs are allowed to go on strike. Something about the Hippocratic Oath, I think. Of course, the anesthesiologists could just stop giving epidurals to OB patients, and that might get some attention without jeopardizing care... but I don't know that they're that dedicated to the OB cause

I think since everyone else has marched on Washington, maybe the doctors should all skip work and go set on capital hill until something is done about the frivolous lawsuits and lowered reimbursements.

 

[Jiminy Cricket]

I think since everyone else has marched on Washington, maybe the doctors should all skip work and go set on capital hill until something is done about the frivolous lawsuits and lowered reimbursements.

I totally agree. Whether it is against the Hippocratic Oath or not, the current situation is ridiculous and indirectly damaging patient care, so going along with the current system is in a way indirectly going against the Oath of do no harm. Change is needed and must happen. Change will only come from Obgyn docs, not Anesthesia etc.

The time has come to protest. Family docs can still take care of the pregnancies when we are on strike.

 

[DrWuStar]

A lot of the attendings at my school say that the malpractice crisis will resolve in the next few years, likely before we are done with residency, and recommend not basing our career choices on the possibility of litigation. I agree that it's hard to know what to do.

 

[DoulaMD]

Don't worry the midwives can take over while you are on strike

 

[Carbo/Taxol]

Doula...good thought although who do you think the malpractice attorneys will go after next when the midwives practice without their physician back-ups?

 

[Carbo/Taxol]

While it would probably work, I don't think docs are allowed to go on strike. Something about the Hippocratic Oath, I think. Of course, the anesthesiologists could just stop giving epidurals to OB patients, and that might get some attention without jeopardizing care... but I don't know that they're that dedicated to the OB cause

With a screen-name like that you would think you would be all for a country-wide physician strike... As Ayn Rand would probably put it, why aren't physicians allowed to go on strike? We are providing a service that is a product of our own mind and abilities. No one has a right to say what we can and cannot do with our mind and we should not be held hostage and forced to provide our services simply because society expects us to without even a say in what we are reimbursed. As malpractice premiums and awards continue to rise, medicare and medicaid reimbursements continue to go down. As government reimbursements go down the commercial reimbursements also go down. The noose is tightening....

Just playing devil's advocate....I personally think that a strike is not necessary at this time although I do think that as Ob/Gyns we do have to present a united front on these issues. Fortunately, ACOG seems to be taking an organized an pro-active approach. We as new physicians and future physicians should be encouraged that our national organization seems to be focused on our interests, but we shouldnt just let it end there. We should get involved and remained informed of the current developments. I do not think that the malpractice issue can continue without restraint indefinitely without some kind of intervention whether it be capping jury awards, limiting attorney reimbursements, actually making malpractice trials a jury of peers (physician panels), etc.

Although this is a hot topic in the mainstream media, I try to emphasize to the medical students that rotate on our service that there are plenty of great and rewarding reasons to go into our field. Malpractice should be a consideration, but it should not be the ONLY consideration. Maybe my tune will change when I am sitting in that courtroom, but for now I will remain optimistic....and thankful that I love Oncology.

 

[Tired Pigeon]

A lot of the attendings at my school say that the malpractice crisis will resolve in the next few years, likely before we are done with residency, and recommend not basing our career choices on the possibility of litigation. I agree that it's hard to know what to do.

Just curious -- what makes them think this will be happening? Our attendings seem more pessimistic.

 

[DoulaMD]

By the way, what are the most common reasons that people are suing malpractice for? Perhaps those should be the reasons addressed. I mean it's sad that we only rank #42 in the world for Infant Mortality Rate. Any suggestions on improving that?

 

[vegetables]

yeah, i bet if we actually covered everyone in this country and everyone could get prenatal care, that number would certainly improve.

 

[Carbo/Taxol]

yeah, i bet if we actually covered everyone in this country and everyone could get prenatal care, that number would certainly improve.

How do you propose we "cover" everyone? More government intervention in healthcare? Read the first paragraph of my last comment. As far as prenatal care...we cannot force people to see the doctor. You would be surprised how many people with insurance, medicaid or commercial, I have seen in triage at term with either limited or no prenatal care by their own choosing. It boggles my mind why this occurs, but whether it be poor access or sheer disinterest, the option is usually there..they just choose not to do it. Even people without insurance at all, at least at my hospital, have the option of prenatal care and to be started on some kind of low payment plan. Now, I know that the system is not perfect and there will be some women who for one reason or another will "fall through the cracks" so to speak. However, health departments and public hospitals are doing a much better job of working together and reaching out to the community in order to minimize this.

This being said, I do not think that poor access to prenatal care and poor insurance coverage is what is fueling the malpractice litigation. Crudely put, it is the high awards that make it worthwhile for the attorneys to pursue these cases. Even in cases with little or no fault on the part of the medical staff, the attorney has the edge especially with increasingly sympathetic juries who have already been primed to distrust the "greedy, reckless physicians." Fortunately, it appears to me that society is starting to see through these frivolous lawsuits. However, until this can be controlled, the attorneys will keep trying....what is 33% of 2 million?

 

[3dtp]

By the way, what are the most common reasons that people are suing malpractice for? Perhaps those should be the reasons addressed. I mean it's sad that we only rank #42 in the world for Infant Mortality Rate. Any suggestions on improving that?

Yeah. We can stop performing heroic measures in the NICU and L&D to keep very premature babies alive. This is not an option I would choose, personally. One of the possible reasons we rank 42 on that list has to do with the definition of Infant Mortality. Another is we are capable of record keeping on nearly every pregnancy/birth/death which is frequently not the case in under-developed/developing nations for technical or political reasons. The devil is in the details and the statistics.

Infant mortality is defined as number of children dying in the first year of life per live birth. We do what most countries consider highly heroic efforts at very great expense in PTL which in other countries would be classified as a stillbirth. A baby born on the cusp of viability is far more likely to get a chance and skew the statistics in the US than in any other country in the world. Many countries who obtain technological advances in obstetric/neonatal health care experience paradoxical increases in infant mortality. According to Gaby, 2/3 of the infant mortality in the US is due to PTL/fetal health in-utero. 1/3 is due to lack of proper prenatal care, or maternal indiference to maternal-fetal health.

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Mark Twain: "There are three kinds of lies. Lies, Damned Lies and Statistics."

 

[DoulaMD]

Many countries who obtain technological advances in obstetric/neonatal health care experience paradoxical increases in infant mortality.

Do you ever wonder if any of these technological advances may be part of the reason the infant mortality rate is so high. More specifically the high rate of induction in the US. We have a fairly high rate of induction for mothers before 42 weeks that have no medical need for it. It seems to be done for convenience a lot of the time. Being induced also makes it more likely for C-sections and premature birth due to bad estimates on due dates. I imagine that would effect the infant mortality rates. Any thoughts?

 

[Carbo/Taxol]

Do you ever wonder if any of these technological advances may be part of the reason the infant mortality rate is so high. More specifically the high rate of induction in the US. We have a fairly high rate of induction for mothers before 42 weeks that have no medical need for it. It seems to be done for convenience a lot of the time. Being induced also makes it more likely for C-sections and premature birth due to bad estimates on due dates. I imagine that would effect the infant mortality rates. Any thoughts?

At my institution, we do not typically induce someone prior to 42 weeks unless they have a medical indication, a favorable cervix, and good dating. Some medical indications prompt us to induce women even when there cervix is unfavorable (which may increase the rate of C/S) or when they are preterm (such as a 32 week pregnancy complicated by severe pre-eclampsia). This may have an effect on the mortality rate; however, we typically do not induce uncomplicated pregnancies prior to the 41st week. There appears to me to be trend in private practice to do induce earlier whether it be for convenience or as the topic of this thread points out...litigation. Imagine what would happen if you had an FDIU at 41 weeks secondary to placental insufficiency..."but doctor, wasnt she past her due date? Shouldn't she have been delivered?" I am not condoning it, just rationalizing.

 

[johankriek]

Crudely put, it is the high awards that make it worthwhile for the attorneys to pursue these cases. Even in cases with little or no fault on the part of the medical staff, the attorney has the edge especially with increasingly sympathetic juries who have already been primed to distrust the "greedy, reckless physicians." Fortunately, it appears to me that society is starting to see through these frivolous lawsuits. However, until this can be controlled, the attorneys will keep trying....what is 33% of 2 million?

medical malpractice has never in this current form been about awarding patients.... its about awarding attorneys .. the fact that patients get something out of it is just a byproduct

if you wanna change the system and just decrease malpractice drastically.. just put a cap on the amount that lawyer retains.. malpractice claims would all but disappear because there is not enough in it for lawyers..

but lawyers make the rules in this country..

I feel sorry for obstetricians in this country everytime i see them.. It is Pure torture. especially dealing with the know it all L and D nurses

 

[WhoisJohnGalt]

With a screen-name like that you would think you would be all for a country-wide physician strike... As Ayn Rand would probably put it, why aren't physicians allowed to go on strike? We are providing a service that is a product of our own mind and abilities. No one has a right to say what we can and cannot do with our mind and we should not be held hostage and forced to provide our services simply because society expects us to without even a say in what we are reimbursed. As malpractice premiums and awards continue to rise, medicare and medicaid reimbursements continue to go down. As government reimbursements go down the commercial reimbursements also go down. The noose is tightening...

I didn't say that we SHOULDN'T go on strike or that we that it's WRONG to go on strike... merely that our current legal system and medical licensure system wouldn't allow it. Of course I don't think that's reasonable; when healthcare is considered a right rather than a privilege, that "right" is to my mind, and that's absurd. Unfortunately, in the current system, in order to become a physician and do the work I want to do, I have to take that oath, and I have to uphold it, or risk society taking away my license and not being able to find patients.

 

[oldbearprofessor]

Do you ever wonder if any of these technological advances may be part of the reason the infant mortality rate is so high. More specifically the high rate of induction in the US. We have a fairly high rate of induction for mothers before 42 weeks that have no medical need for it. It seems to be done for convenience a lot of the time. Being induced also makes it more likely for C-sections and premature birth due to bad estimates on due dates. I imagine that would effect the infant mortality rates. Any thoughts?

Mortality associated with iatrogenic preterm delivery in the US, that is, the elective delivery of infants who are actually 36-37 weeks but were thought to be full-term is essentially zero in the modern era of surfactant and advanced respiratory support modes. Actually, it was low before that since ventilation for HMD became widespread (after the death of Baby Boy Kennedy from HMD in 1963). That does not mean that iatrogenic HMD in a 36 weeker is a good thing, just that it does not add to the infant mortality rate.

 

[Carbo/Taxol]

I didn't say that we SHOULDN'T go on strike or that we that it's WRONG to go on strike... merely that our current legal system and medical licensure system wouldn't allow it. Of course I don't think that's reasonable; when healthcare is considered a right rather than a privilege, that "right" is to my mind, and that's absurd. Unfortunately, in the current system, in order to become a physician and do the work I want to do, I have to take that oath, and I have to uphold it, or risk society taking away my license and not being able to find patients.

just giving you a hard time...

 

[Carbo/Taxol]

medical malpractice has never in this current form been about awarding patients.... its about awarding attorneys .. the fact that patients get something out of it is just a byproduct

if you wanna change the system and just decrease malpractice drastically.. just put a cap on the amount that lawyer retains.. malpractice claims would all but disappear because there is not enough in it for lawyers..

but lawyers make the rules in this country..

I feel sorry for obstetricians in this country everytime i see them.. It is Pure torture. especially dealing with the know it all L and D nurses

I agree...however, the unfortunate thing is that if you cap attorney awards and fewer take on cases, some patients who truly suffered negligence that caused a significant harm may go without compensation. That is unless they find an attorney with enough ethics and morals to take on the case regardless of award. The solution to this malpractice "crisis" we are all talking about will have to be a little more complex than just limiting the attorneys' awards.

As far as the L&D nurses go...you gotta love em...they can be a residents best friends.

 

[sirus_virus]

I didn't say that we SHOULDN'T go on strike or that we that it's WRONG to go on strike... merely that our current legal system and medical licensure system wouldn't allow it. Of course I don't think that's reasonable; when healthcare is considered a right rather than a privilege, that "right" is to my mind, and that's absurd. Unfortunately, in the current system, in order to become a physician and do the work I want to do, I have to take that oath, and I have to uphold it, or risk society taking away my license and not being able to find patients.

Not if everyone agrees on the strike. If you are going to accept every single work condition just because you "took an oath" then good luck. I predict that in my lifetime OB/GYNs will be sued out of existence, and only at that point will change come. BTW, why the hell are you guys still going into OB/GYN? This is like someone telling you to come and get slapped, and you actually go. The present system does not deserve well trained OB/GYNs, or they at least don't appreciate your value, so screw'em.

 

[sirus_virus]

I agree...however, the unfortunate thing is that if you cap attorney awards and fewer take on cases, some patients who truly suffered negligence that caused a significant harm may go without compensation. That is unless they find an attorney with enough ethics and morals to take on the case regardless of award. The solution to this malpractice "crisis" we are all talking about will have to be a little more complex than just limiting the attorneys' awards.

As far as the L&D nurses go...you gotta love em...they can be a residents best friends.

You could increase the penalty for filing frivolous suits and reduce the threshold definition of what a frivolous suit is. As it stands lawyers are filing way too many meritless lawsuits and someone needs to reel it in.

 

[Noyac]

By the way, what are the most common reasons that people are suing malpractice for? Perhaps those should be the reasons addressed. I mean it's sad that we only rank #42 in the world for Infant Mortality Rate. Any suggestions on improving that?

I was under the impression that the reason the US is as bad in the Infant Mortality Rate as it is was because the premies (even down to the 24 weekers) are included in the statistics and they are not included in many other countries. Any truth to this? If so then I know how to improve those numbers.

And someone mentioned anesthesia could stop placing epidurals. I don't understand how this helps your cause.

 

[3dtp]

I was under the impression that the reason the US is as bad in the Infant Mortality Rate as it is was because the premies (even down to the 24 weekers) are included in the statistics and they are not included in many other countries. Any truth to this? If so then I know how to improve those numbers.

And someone mentioned anesthesia could stop placing epidurals. I don't understand how this helps your cause.

I do believe this to be true. This is the problem with the statistics that are oft quoted. The definitions do vary from political jurisdiction to political jurisdiction.

The only consistent definition for statistics and record keeping has nothing to do with OB (at least directly) and that is the FIGO staging for cervical cancer. They reduce staging to the least common denominator to insure that countries without advanced imaging can stage cancer the same as those with. Me, I still order the CT scan when I'm treating cervical cancer.

So, the question is, if we can adopt a uniform definition of infant mortality, what will the numbers say. The WHO has used a 5 year mortality rate in which the US compares favorably, as does the rest of the industrialized world. I forget the exact statistics now.

 

[chrisisinnocent]

Just talked tonight to a Perinatologist who is an ACOG representative about this. Just keep in mind a few facts:

- Malpractice premiums vary widely by location. Las vegas 110K a year while Ohio it's 13K a year. This is because rates of lawsuits and amounts of awards very really widely across the country.

- The only people that really get screwed over by this are the ones who practice solo (they have to pay the full premium, a group spreads it around), and family practice docs who cannot afford the extra premium on 100k or less a year incomes.

- If you practice in a hospital or a large group this will not affect you. Most malpractice suits never make it to court and the reason many get settled early is because it costs on average 80k+ to sucessfully defend a lawsuit.

- Finally the only scum in this whole mess are the lawyers. Only 15% of malpractice awards go to the patient, 85% gets gobbled up by the lawyers.