The proportion of medical procedures unsupported by evidence may be nearly half

This is a good point, I concur.

I agree doctors should be held accountable, but it is not the case in the U.S.

This article does a great job explaining the issue about malpractice in the U.S.

I have no idea whether malpractice is overblown, but I do know that it doesn't prevent bad doctors from practicing.

(https://m.huffpost.com/us/entry/us_5a1f4595e4b0dff40be0362f)

>"Our current malpractice system doesn’t work. Why? Because 90 percent or more of malpractice cases don’t even go to court. And the amount of money – and it is vast – that is attached to this “medical malpractice settlement industry,” if you will, is divvied up in such a way that much of it doesn’t reach the patient. It goes to lawyers, it goes to the courts, and it goes to so-called experts who testify on behalf of the defendant or the plaintiff."

The best situation I have seen is where people do sue, but hospitals provide legal protection for their employees (public sector in western Europe). Employees there still fear for their jobs, but not enough to put patients through nearly as much useless and risky crap as in the US. Patients there are also far less prone to sue, since the success rate of legal action is low. All in all, everyone seems to benefit from a little less tension in the system.

Of course, you will always find people who feel (perhaps rightly so) that they were wronged, and that we should cut the hands of the bad docs. Finding balance in those matters is a difficult social exercise.

Because the doctor/hospital side -- further backed by insurance -- typically has much more power and inertia than the patient. And these reforms add often quite severe limits that don't actually cover some or many patients' actual damages (cost of continuing care alone, not to mention quality of life).

Absent meaningful penalties, mistakes become just "a cost of doing business" and there may be little incentive to actually fix them. Or to punish the chronic bumbler -- where bumbler can actually mean de facto criminal negligence (in the eyes of reasonable people, regardless of legal outcome).

AND, that's what an awful lot of what intersects "white collar" and "business" comes down to, in the U.S. Money. It's our often poor substitute for real justice -- and for being more proactive to prevent problems before they happen (e.g. by spending smaller sums, up front, to better the process)

I'd be more supportive of a... "more rational" system of compensation, if ongoing care were guaranteed. The medical accident doesn't mean you will end up un-insurable. Or even on the street or in a family members bedroom or on a friend's couch, because you can no longer work in your career.

If it were a real medical system that pro-actively worked to improve itself, minimize mistakes and bad behavior, take responsibility for its outcomes, and provide ongoing care. Instead of limited fee for service transactions, regardless of the quality of said service.

All the more so as medical networks grow into behemoths (even if that was promoted to some degree by the insurance and legal systems), they employ tremendous legal resources on behalf of their own interests. Legislatively limiting the other side's leverage in dealing with them? No, thanks.

P.S. I may be mistaken, but I have a recollection of reporting on this... maybe 5-ish years ago, or a bit more. Study of malpractice settlements and judgments found that most were not outrageous and sought to meet the real resultant needs and injuries of the plaintiffs.

The "big payout", "ballooning expenses" story was/is to some significant degree manufactured. Citing extreme, outlying cases that are a small minority of what's really going on.

That is, the story has a political basis. The agenda of certain self-serving interests.

Whichever side you're on, with regard to "tort reform" with respect to medical malpractice, I think we all need to see the complete and unvarnished numbers. Settlements as well as judgments.

Again, the secrecy surrounding this is not doing us, the public, any good. With actually, comprehensive data, perhaps we could come closer to an agreement on policy, regulation, and legislation, in this area.

What about the whole hypocratic oath thing? Or isn't that natural?

I think the issue is that we look at air travel as inherently risky and as such want to do everything to reduce risk. Over the past 100 years we've come to deeply understand risk management in the space and as such are careful to only assign blame in cases of blatant negligence (he wasn't IFR rated but flew into the side of a mountain while in a cloud) while treating other accidents as learning opportunities (Ok, the pilot fucked up but the MU-2 handles differently than most planes, we should require more training in type...).

The industry also had it's fair share of litigious behavior but it was generally recognized that it wasn't productive and legislation has since attempted to keep it at bay with varying degrees of effectiveness

It makes me wonder why similar practices aren't followed in the medical field...

All the harder to remain or get well, whilst in the middle of a fight.

Sometimes doctors. Insurance (and, any number of types of insurance, depending on what's happened). Institutions (hospitals et al.). Lawyers.

Then slap non-disclosure on top of it all, to make it all the more likely the next guy enters, unaware.

That's my "word for the day", with respect to health care in the U.S. "Adversarial".

I'm going to stop writing and just reflect on that, for a while.

(And even when it's not, it can/could be. Something that hangs over the head of every clue-ful patient, as they go through the system.

Maybe it's easier to be someone who doesn't follow the news and keep up on this, who goes through the system blissfully unaware and happens by chance or whatever to avoid the major pitfalls.

I feel a bit guilty, writing about this when a lot of the world struggles to achieve basic coverage. But, I've had the U.S. system screw me over, significantly, more than once. I used to be more trusting. Now, I delay and delay -- which creates its own problems.)

However the political processes surrounding hospitals will block this. For example, there are lobby groups in the community that literally scream blue murder if decisions like "it isn't rational to live" are made in public. In Australia, we've been fighting the good fight to get euthanasia legalised for as long as I can remember. It is slow, hard going.

A system that can't let people go is simply never going to allow public investigations - it hasn't accepted that quality of life takes primacy or that death is sometimes inevitable. Medical care is very political and they cannot support the results-oriented culture of the airlines.

A good portion of that fifty or whatever percent of procedures that don't any backing evidence exist through being grandfathered-in from the medical tradition. Beyond the germ theory of disease, medicine circa 1900 was appalling in multiple ways.

Medicine continually advances, at least in parts. Hopefully that advance can continue against the grain of multitude of problems we see.

It seems to me that the main skill of a doctor is making the correct diagnosis. Once that's done, treatment (at least in the vast majority of cases) is going to be perfunctory.

And even the diagnosis itself is going to be, in most cases, the "most likely" condition that explains the patient's symptoms.