Sermo, malpractice, and Howard Dean

Sermo’s Daniel Palestrant got on TV with Howard Dean. It was an amusing (and short) little debate which you can find here.

The best moment was at the start when Dean claimed that Sermo was just a poll. Palestrant pointed out that Dean spent last week explaining how reflective online communities were about what their members thought. Given how Dean rose to national prominence I’m a little surprised that he’s trashing the Internet!

To be honest I thought Palestrant (who I know and like) spent a little too much time having a go at the AMA (which Dean doesn’t support and is probably surprised that backed the House Bill) and not much going after the public plan that Dean was proposing. Palestrant did say at the end that physicians should be paid commensurate with their training while Dean said that salaries were the way to go. But you can imagine getting to some agreement there. Even though Palestrant (as a good THCB reader) pointed out that there’s no real reform in the current bills.

But it does seem to me that Sermo’s results are reflective of one major thing.

American physicians—whether justified by the facts of its relative importance in the American system or not—are incensed about malpractice and are further incensed that no one is currently talking about malpractice reform as being part of any bill.

I think that this is a strategic mistake by the Dems and the trial bar. Big bad corporations are able to cloak themselves in the rhetoric of tort reform by hiding behind the physicians. If the trial lawyers let this segment go, they’d be in much better shape beating back future tort reform efforts.

Meanwhile the malpractice system doesn’t even “catch” half the malpractice—and all the evidence shows that saying “sorry” with a no-fault compensation scheme for actual harm caused by medical errors (which are rarely one individual’s fault) is all the patients want.

Beyond malpractice I read a lot of comments on Sermo about the bill (not all 10,000 though!) and it seems to me that the docs on Sermo are split. My sense is that 65% want to go all cash and 35% wanting to go to some kind of salaried single payer system. And they are all mad at the AMA.

Which indicates to me what THCB readers already know about online forums: If there ain’t agreement going in, you’re unlikely to get it going out!

More on Sermo and the AMA:

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14 replies »

  1. I’m appalled at how gullible and how uninformed we , the US public are in reguards to health care in the US.DEATH PANELS- gullible, gullible! Insurance companies do deny test and care to people .I see it happen everyday in the hospital I work in. My friend from Sweden is right. The US is a ME ME country. We do not believe in being are brothers keeper. Health care cost will continue to go up , more people will become uninsured and it is our fault. We are a selfish country. By the way I am paying 369.00 dollars a month for my daughter’s health insurance. Her job does not have an insurance plan.

  2. A few points:
    If physicians become salaried, then who is the employer?
    Though a disparate group, doctors are united on one issue – the need for Med Mal Reform.
    Finally, doctors are very small fish in a very large ocean overstocked with predators. Survival would be best achieved by coming together in one voice. As Franklin said, “We must all hang together, for assuredly we will all hang separately.”

  3. We need torte reform not just for medicine but across the board. It is an obscene mischarriage of justice that justice is for sale. Lawyers simply make way too much money for their level of training.
    Why not put torte lawyers on salary? If it works for physicians, improves the delivery of health care, why wouldn’t it for for the local ambulance chaser.
    The cost of litigation is enormous and places an incredilbe burden on our society.
    1/3 of the cost of an IUD or a small airplane for that matter is to cover litigation.
    No one should make millions standing before a court of this country. We wouldn’t tolerate a heart surgeon walking out of the OR with that kind of reimbursement, why do we tolerate lawyers doing the same. We don’t give Judges a cut of the action, why do lawyers make so much? And they’re using a public resource, our court system..
    Without torte reform, alot of older physicians such as myself will simply retire early.
    It’s just not worth it anymore..

  4. Matthew:
    Did you have to pay anything, “in kind” or otherwise, for your observer pass? How did you come to get it?
    As I said, I don’t use Sermo in general as I have found it to be largely a gripe forum, except for the actual (anonymized) medical problems, which are interesting.

  5. FYI I have an observer pass into Sermo which I use only to view comments. And no I don’t sell, repeat, or do anything with the data other than make general synopses like the one in this aticle

  6. bbf:
    yes, I knew that, which is why I asked Matthew the question. I wondered if they “sold” him the access. There was some debate among members about a year ago when Dr. Palestrant allowed the AMA and some pharma companies (?paid) access, supposedly to “see what doctors are thinking.” Frankly, what some of them are thinking scares me; physicians are an angry group these days. (I am retired, so I am just an angry patient now.)

  7. What I found interesting is that while Sermo makes note of AMA’s profits from CPT, no one asked Palestrant how Sermo makes its money, which may be the answer you are seeking, Bev M.D. To wit: the only people who can participate in Sermo for free are MDs. Industry groups, Bloomberg Financial, and other marketers who want to know what doctors really think and are talking about are the ones who pay for it. I expect the site makes that clear to those who sign up, but a quick poll of some of my physician friends showed they didn’t know that salient fact.

  8. What should be apparent is that the AMA does not largely represent physicians in the US anymore (less than 30% membership nationally declining year after year) and that are as a whole as is nearly as loathsome and detestable as other organizations who taking a general beating from the general public including AHIP and Pharma.

  9. Matthew;
    I am curious when you said “I read a lot of comments on Sermo” – you now have access to Sermo? I thought it was supposed to be restricted to physicians?
    Not criticizing as I rarely use it; just curious.

  10. Maggie Mahar was on The Ed Show on MSNBC last night telling us about how Medicare reform could pave the way for health care reform. The Bill includes suggestions on changing what we pay for and how we pay for it, rewarding providers for the quality of the care they provide rather than the quantity. A public sector insurance plan would incorporate many of Medicare’s reforms, offering Americans better care at a lower price.

  11. I think Palestrant viewed the forum as more of a debate than Dean did. As noted and seen in the interview, Dean is far more experienced in these tactics.
    To me the major take home message should be that the AMA does NOT represent the mind-set nor inclinations of most physicians. Current political discussions seem to always fall back on “that’s what the AMA agrees to..or..we have the support of the AMA”. This is nothing more than good marketing by the AMA over many years.
    We need to continue to emphasize that the AMA is NOT the end-all of physician’s voices and wholeheartedly support collective social networking forums such as Sermo despite Dean’s flip-flopping on their usefulness.

  12. There is more malpractice now than ever before as hospitals and doctors alike cut corners to make ends meet.
    All medical care is hurried and slipshod.
    Surgeons are performing extras for the few extra bucks.
    Gastroenterologists are performing biopsies when not indicated (on all patients) for the extra $35.
    Communication is abysmal.
    Tests are being duplicated worse than ever before.
    CPOE systems exacerbate the problems rendering epidemic errors and perpetuation of individual errors.
    Nurses have become hospital CEO advocates (for profit)

  13. I take exception to the part that there is no real reform. There is! The benefeciaries are not people. I support Dr. Dean. He was a great governor in Vermont.
    Salaried position will resolve lots of ethics questions. We may have to work then on productivity questions but that can be managed through performance discussions.
    I think the challenge may also come form the fact that we have, more so they themselves have, idolized doctors to god level. So, managing them would be no easy task.

  14. Media forums on TV are guided by the moderator. Howard Dean has had a lot more media experience in the national politic. Dan Palestrant did a reasonable presentation for his first exposure to this forum. The takeaway should have been the AMA does not represent doctors. Dean made this clear as well. The other issue that should have been more apparent is that change is necessary in tort law, and methods of reimbursement. Reimbursement according to training was not a really valid argumment, but revising the reimbursement system from procedural to a factor for cognitive services is a key aspect of reform. The mentioning of the CPT codes being owned and copyrighted by the AMA was lost in the discussion, as well as the fact that the AMA profits from this as the insurance companies pay for using this tool as a measure for payments. Overall a good job, Dan Palestrant. I was probably one of the first users of SERMO….It’s great to see how it has developed. And it is only about two years old!!