I am on a list waiting for a pancreas it would not only save my life but also greatly improve the one I have now. I fully respect those who do not feel comfortable with donating their organs it is a decision which is up to the individual. However why would you not want to help someone at no cost of your own as many have said you will be dead. As to doctors not helping you if you are in need just to let you die to harvest your various organs I am sure it happens sometimes but how likely is it to happen to you? It isa probably just as likely that someone will kill you. As far as I am aware there are safeguards to prevent this and a penalty as for all crimes.
But if you no longer have any use for your organs would you not rather have them put to use?
Doctors are, in a lot of cases, obligated to provide lifesaving services without expectation of compensation. In my state, according to a lecturer we had, I’m obligated to stop at the scene of an accident and offer assistance if I pass by one. (At least, I will be two weeks from Saturday.) Most docs don’t, because there’s really no point; the doc can’t do much without equipment, and when the equipment gets there, it will have paramedics and EMTs with it, who are trained to handle this sort of thing better than, say, your average internist.
Emergency rooms are obligated to not turn anyone away, regardless of whether he or she can pay.
pohjonen–if you needed a transplant tomorrow and you don’t have those kinds of funds lying around, it would almost certainly make you Medicaid eligible, so the costs would be covered. The problem is that you would usually have to get near that point before would be eligible, so the preventive care that might keep you from needing the transplant wouldn’t be covered. That, however, is another rant.
Dr. J
I was with the “surely doctors treat everyone the same” crowd until I read this.
I was reminded of my great uncle in the hospital. He is unmarried, no children, and very old. My mother, his neice, was closest (geographically speaking), and the only one at the hospital for a while. The doctors were talking about how serious it was, and how there was not much to do.
Well, it turns out that even though he is unmarried and has no children, he has 7 brothers and sisters, and they and all of their children and grand children started showing up when everyone heard the serious news.
As more and more people started showing up to visit, my mother was surprised at how the doctor’s prognosis kept improving and improving, and all of a sudden medical options were suggested that weren’t mentioned earlier.
What do I take away from this story? The doctors seemed to be more motivated once they found out he had someone to live for (or was it once they found out that there were more plaintiffs than you could shake a stick at).
I’m with Surreal. When information is readily available, it is simply human nature to obtain the information and to be influenced by it. It’s also a fact of life that institutions, if they can get away with it, will put their own interests ahead of the interests of the constituents that they supposedly serve.
You can’t tell me that the life-saving guys (paramedics, emergency room people, etc.) NEVER know whether a patient is an organ donor while they are trying to save him.
And I wouldn’t be surprised at all to find that the life-saving guys are compensated in subtle ways by the organ-harvesting guys.
And don’t get me started about doctors not acting in their patients’ best interests. You have to watch doctors like a freakin’ hawk and question everything.
I strongly disagree. While overtly neglecting a patient may be uncommon, I’m sure that in medicine, there are a lot of gray areas where the doctor can make a judgment call, unaccountable to anyone.
Second, when a doctor does something that isn’t quite right (i’m not talking about serious mistakes), do you think it’s always reported by other doctor’s who witness the incident? Come on!!
There are lots of reasons people get better prognoses. First, people who are going to get better with time do get better with time. Second, it is always good to let people who have serious problems and their relatives understand the gravity of the situation as soon as is practical. These people often get better, but things don’t always turn out and people should be prepared for bad outcomes if there is a good chance these could happen. It is true old people with many social suppots are healthier and deal with illness much better than isolated old people, but I think it is premature to say the cause for better prognoses was the fact he had more visitors.
They usually do not know. Almost never. I strongly doubt this would impact on a decision to withdraw life-saving treatment. I do not think financial reimbursement plays a major part of this for anyone, and am sure lifesaving guys aren’t compensated by organ guys. In medicine, compensation comes int he form of job satisfaction more often than you believe and this is never more true than in a case like this.
Making judgment calls is a very important part of being a good doctor. Other doctors know this, and would not (nor shouldn’t) report a doctor just because they handle things in a different way than they would. Obviously this is different in a serious error, but the standard of care is often reasonably well defined.
Part of the problem is that instead of fixing the system, protocols or changing things to minimize error, the legal system and public prefers to blame an individual doctor and hold them responsible for all errors even though no doctor is perfect. Your medical care would be better and your costs would be much lower if you concentrated more on fixing problems and less on blaming people.
Any cite for this? Otherwise, I’m pretty skeptical. Doesn’t it happen that a nurse, paramedic or whoever looks at the patient’s driver’s license?
Well, do you think that other circumstances make a difference such as the patient’s race, age, financial condition, etc.? If you’re answer is “no,” then your viewpoint is pretty naive IMHO. If the answer is “yes,” then why couldn’t organ donation status make a difference?
Will you at least concede that in many situations, doctors’ judgements are corrupted by financial considerations? Again, if your answer is “no,” then IMHO your viewpoint is pretty naive.
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And I’m sure that there are doctors who consistently make judgment calls that other doctors would consider questionable. And I’m sure that many judgment calls are affected by the circumstances of the patient. In any event, I was responding to a poster who claimed, in essence, that any deficiency in the care of an organ donating patient would be easily recognized. Can we agree that this is not the case?
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Are you saying that if a patient is injured because of a doctor’s error, it is somehow wrong or improper for the patient to seek redress by means of a civil lawsuit?!?
Did I say it was wrong for people to seek redress for serious error? It is wrong for this to be a normal reaction anytime things do not turn out well. I see a lot of Canadians who go to the US on vacation and pay thousands of dollars for completely unnecessary tests ordered for extremely unlikely medicolegal reasons.
Having spent thousands of hours working as an emergency room doctor, my humble opinion is that looking for the driver’s licence very much plays second consideration to promptly treating the patient. This may be unique to Canada if it is true drug allergies are listed on licences in other countries. But usually an intensive, immediate search of wallets is done when the identity of the person is unknown or a blood transfusion is being given. In my naive humble opinion, I find it extremely difficult to believe organ donor status affects treatment. This holds in spite of my knowledge of how doctor’s are compensated. I also agree with many of surreal’s points.
Organ donor here, and for one very good reason. The alternative. I’ve spent years caring for people who were/are “brain dead” and the aversion I may have for being sliced and diced during an organ harvest doesn’t hold a candle to the absolute horror I have to being kept in the purgatory of a persistent vegatative state while needing to have my every last bodily function attended to.
http://www.geocities.com/HotSprings/Oasis/2919/pvsdef.html
Well. I’ll comment briefly. I had a bilateral lung transplant in december of 2001. As a beneficiary of organ donation, i encourage everyone to talk with their families and their physicians (as applicable) about donation. I don’t know who my new lungs came from. I may never find out, but, i plan on using them to the best of my ability. Her family let them harvest them, and i’m not going to waste my new chance.
Another quick point, i have cystic fibrosis. I just passed the mean life span for CF patients in the US. At this point, i’m watching more and more of my peers die, some due to the long waiting lists for organ transplantation. I only had to wait 6 months. I was lucky. A friend of mine died after waiting for over 2 years.
The way i figure, and of course this is my opinon only, that folks who for non-religious reasons (though not limited to those reasons, of course… and all those other caveats so not to insult whoever) are opposed to donation, due so mainly because they haven’t had to face the harsh reality of a condition that requires donation, either directly or through a family member or friend. Have to go through the process yourself, or watch someone waste away waiting, and attitudes change.
Am i bitter? A bit maybe. But all i can do now is try to let folks know that donation does help.
You said the following:
Excuse me, but what’s wrong with holding doctors responsible for all errors?!?
Honestly, I’m a little skeptical about this too. It’s interesting that the medical community profits from these “unnecessary tests” that they supposedly order for “medicolegal reasons.” But I won’t push the point.
Also, when “things do not turn out well,” what percentage of the time does the patient bring suit? Honestly, I wouldn’t be surprised if it were less than 20%. Do you have a reference on this point? Or do you just sort of know that a lawsuit is a “normal reaction”?
Well, I can’t argue with your personal experience, but you’ll need a reference to convince me of this claim. By the way, how do you know whether to call up the organ-donor people?
Also, I really would appreciate answers to my questions from before. In particular . . .
Do you think that the patient’s race, age, financial condition, etc. make a difference in how he or she is treated?
Will you at least concede that in many situations, doctors’ judgements are corrupted by financial considerations?
Doctors are often, and regrettably, influenced by financial condsiderations. This is regrettable, but I don’t see how they are involved in the issue of organ donation. I do not believe the vast majority of doctors treat patients differently on the basis of race, but there are always a few bad apples. Patients of different age should be treated differently – pediatrics and geriatrics are different, but I do not believe this is a common source of discrimination. I do think people who do not speak English are treated to a lower standard than people who do not speak English. In Canada, people have universal coverage; anecdotally, I suspect people in the States are treated differently on the basis of how they are insured, which reflects an economic bias.
The problem with holding doctors solely responsible is that “serious error” is hard to define. No one denies doctors need to stay up to date on recent knowldge, which changes constantly. No one denies doctors need to be competent. No one can seriously say they never expect errors in human judgement to be made. But many medical decisions are not cut and dry, and in ill patients things often turn badly regardless of any interventions we have available. Emotions run high, and the problem with many legal cases is medically no mistakes were made even if the patient’s perception differs.
A major goal when a mistake does occur is to minimize the chance of it happening again. If the solution is to get rid of the doctor, this process does not occur. The problem is not solved if no one wants to deliver babies in rural areas due to fear of lawsuits. The problem is not solved if people pay three times as much for their health care for protection against the weird and wonderful rare exception.
Well, the problem is this. The organ donation guys make a lot of money off of transplanting organs. So when the life-saving guys refer a (former) patient and his or her family to the organ-donation guys, it’s worth a good deal of money to the organ donation guys. Under such circumstances, it is simply human nature for the organ-donation guys to find subtle ways to compensate the life-saving guys. In my profession (law), I see this principal at work all the time. If the life-saving guys are being compensated for organ donation, it could easily corrupt their judgment. Now, you may think that medicine is different because human lives are at stake, but you’ve already basically conceded that “[d]octors are often, and regrettably, influenced by financial considerations.” So is it really that different?
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We have to distinguish between proper and improper discrimination. I think that the latter is very common.
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IMHO, the fact that it is difficult to determine negligence is not an excuse to absolve doctors from liability (IMHO). Every tort claim has this problem. That’s why we have judges, juries, etc.
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Well, I have no problem letting a jury and judge decide whether a doctor acted properly or not and awarding money damages as appropriate. Certainly the doctor himself should not be making that decision. Who would you have decide?
There is also the goal of compensating the patient for any injuries suffered as a result of the doctor’s mistake.
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I thought we were talking about civil lawsuits not doctor discipline. In any event, I don’t think anyone could disagree that if a doctor screws up seriously and frequently enough, he should lose his license. How much and how serious is a question for medical disciplinary boards.
Are people in rural areas more prone to bringing lawsuits? Somehow I doubt it. But feel free to come up with a reference to show otherwise.
More likely, I think that doctors prefer to live in New York, Boston, San Francisco, etc.
I wonder how much of a component of the doctor’s bill is medical malpractice insurance. I doubt it’s 2/3.
Anyway, I’d love to see references to back up your claims.
In particular, I’d love to know what percentage of patients who have unfavorable outcomes bring suit against their doctors.
Your claims are very much the humble opinion of someone without a working knowledge of clinical medicine. I have neither the time nor inclination to find references. If I found references,m you would not find them satisfactory. If you wish to believe, as a doctor, I should be responsible if the nurse gives a different medication than I order because I am the doctor, so be it. If you wish to believe that juries always know what a reasonably normal childbirth looks like, you are free to do so. But I see ads all the time looking for rural area doctors who deliver babies, and it is precisely because of folks with your attitudes I would never to obstetrics in the US – where is your cite saying rural folks don’t sue? You have every right to pay far more for your medical care than is reasonable. If you want to think it right and decent you can do that as well. I’ve made my points reasonably, but see little point to debating this further.
Well, you’ve made some pretty extraordinary claims.
Among them, that the normal response of a patient who suffers a bad outcome is to sue his or her doctor and that the reason there is a shortage of doctors in rural areas is because of fear of lawsuits.
I think we both know the reason why you won’t back up these claims.
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Umm, it is not my position that doctors should be strictly liable for the misconduct of others. Do you honestly believe I think so, or are you just pushing down another straw man?
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It is not my position that juries/judges are always right. They make mistakes (just like doctors). Again, who would you have make the decision of whether a doctor should have to pay money damages to his or her patient?
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Look, you made the somewhat extraordinary claim that there is a shortage of doctors in rural areas because of fear of lawsuits.
You refuse to back it up, and you think that I somehow bear the burden of showing that rural people do not sue?
That’s crazy on so many levels.
Umm, you’ve made a bunch of vague and unsupported statements, knocked down a few straw men, and ignored the essential arguments.
The chance of a bad outcome in childbirth goes up as one gets further from a tertiary care center. Even at some of the smaller, less well-equipped hospitals here in Lexington, the difference is not large because if the worst does occur, the baby can be in the UK NICU being seen by the neonatalogist on call in a matter of minutes.
If the same baby is born down in southeastern KY, he might be ten minutes from the helipad and an hour by chopper from the nearest neonatalogist (probably the same one at UK or maybe at UT). Often, the OB is forced to overreach his expertise rather than let the neonate die en route.
I’m not sure if those suffering a bad outcome from childbirth are more likely to sue than most patients, but juries are very sympathetic in such cases. This is reflected in malpractice premiums, as is the difference between rural and non-rural practice. I know of two people in my class as well as a few residents who wanted to do OB in SE KY but chose another area or another specialty because the malpractice premiums combined with the large number of Medicaid patients make it nearly impossible to have a successful OB practice in the area.
Again, it’s all personal experience, but there you have it.
Dr. J
I would think you’re the one making extraordinary claims, and then asking me to provide refernces to support points you make and I don’t. I say none of the forty emergency doctors I know has ever to my knowledge received compensation for an organ donation. You ask for a reference, as if someone has done a reliable double blinded study. I state my opinion that people pay excessive lawsuits in the states and are quick to hold the doctor responsible for things often outside his or her control. You take this to some extreme and accuse me of saying the doctor is never responsible. You make the remarkable implication you suspect doctors of commonly being openly racist. In support of your claims, you ask me to provide cites. You don’t need to look in the want ads of American Family Physician to see fewer doctors want to do obstetrics in the US. You may choose to believe most doctors live in big cities and the babies appear magically in rural areas. I did not say rural folks sued more often, merely docotrs are scared of lawsuits. Make no mistake, this hijack is not a great debate. I never made most of the points you dispute, and I’ll be damned to spend time finding cites for your misquotations.
Your straw-man argument technique is getting really old.
Why can’t you address the actual arguments I make instead of putting words in my mouth? (Hmmm, I wonder why :rolleyes: )
Did you or did you not claim that the normal response of a patient who has had a bad outcome was to bring suit against his or her doctor?
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Please show me where you said that and where I asked for a reference on this point.
Here’s what you actually said:
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If you were actually making a point about holding doctors responsible for other people’s errors, then you did not make it very clearly.
In any event, I said earlier (and I’ll say again) that doctors should not be strictly liable for other people’s errors. This seems like a pretty obvious point to me.
Here’s what I said:
Note also that I said this in the context of discussing discrimination in general, including age-discrimination and race-discrimination.
Like I said before, your need to push down straw men instead of actually addressing my points is getting really old.
Look, you’ll have no problem convincing me that there is a shortage of doctors in rural areas.
Similarly, you’ll have no problem convincing me that many doctors are afraid of lawsuits.
All I’m asking for is evidence linking those two points. If malpractice insurance premiums were significantly higher in rural areas, that would be evidence. If rural residents were more lawsuit-prone, that would be evidence. Even a common sense argument as to why doctors would avoid rural areas because of a fear of lawsuits would help. But simply repeating the two (obvious) points again and again means nothing.
That’s so funny. You put words in my mouth again and again, and then claim that I’m misquoting you. Where exactly did I misquote you?