Commentary: Don't Let Primary Care Physicians off the Hook so Easily

Journal of Law, Medicine and Ethics

Volumn 26, Issue 2, 1998, Pages 113-115

  Hickson, Gerald B ^a  

^a NONE

Author keywords

[No Author keywords available]

Indexed keywords

EID: 0347718226     PISSN: 10731105     EISSN: None     Source Type: Journal    
DOI: 10.1111/j.1748-720X.1998.tb01667.x     Document Type: Article

References (22)

1. See B. Friedland, "Managed Care and the Expanding Scope of Primary Care Physicians' Duties: A Proposal to Redefine Explicitly the Standard of Care," Journal of Law, Medicine & Ethics, 26 (1998): 100-12 ; and G.B. Hickson et al., "Development of an Early Identification and Response Model of Malpractice Prevention," Law and Contemporary Problems, 60 (1997): 7-29.
2. See B. Friedland, "Managed Care and the Expanding Scope of Primary Care Physicians' Duties: A Proposal to Redefine Explicitly the Standard of Care," Journal of Law, Medicine & Ethics, 26 (1998): 100-12 ; and G.B. Hickson et al., "Development of an Early Identification and Response Model of Malpractice Prevention," Law and Contemporary Problems, 60 (1997): 7-29.
3. See Friedland, id.
4. See Employee Retirement Income Security Act of 1974, Pub. L. No. 93-406, 88 Stat. 829 (codified as amended at 29 U.S.C. §§ 1001-1461 (1988 & Supp. V. 1993)).
5. See A. Donabedian, The Definition of Quality and Approaches to Its Assessment (Ann Arbor: Health Administration Press, 1980); and P.W. Newacheck et al., "Monitoring and Evaluating Managed Care for Children with Chronic Illnesses and Disabilities," Pediatrics, 98 (1996): 952-58. Examination of quality in medicine may include studies of patient satisfaction, the process of care, and outcomes. All are difficult to perform and subject to a number of well-documented biases, which make interpretation difficult. Such difficulties are compounded by the tremendous variations on the managed care theme.
6. See A. Donabedian, The Definition of Quality and Approaches to Its Assessment (Ann Arbor: Health Administration Press, 1980); and P.W. Newacheck et al., "Monitoring and Evaluating Managed Care for Children with Chronic Illnesses and Disabilities," Pediatrics, 98 (1996): 952-58. Examination of quality in medicine may include studies of patient satisfaction, the process of care, and outcomes. All are difficult to perform and subject to a number of well-documented biases, which make interpretation difficult. Such difficulties are compounded by the tremendous variations on the managed care theme.
7. See V.R. Fuchs and M.J. Kramer, Determinants of Expenditures for Physicians' Services in the United States 1948-1968 (Washington, D.C.: National Center for Health Services Research and Development, 1972); H.S. Luft, Health Maintenance Organizations: Dimensions of Performance (New York: John Wiley, 1981); G.B. Hickson et al., "Physician Reimbursement by Salary or Fee-for-Service: Effect on Physician Practice Behavior in a Randomized Prospective Study," Pediatrics, 80 (1987): 344; and J. Wennberg and A. Gittelsohn, "Variations in Medical Care Among Small Areas," Scientific American, 246, no. 4 (1982): 120-34.
8. See V.R. Fuchs and M.J. Kramer, Determinants of Expenditures for Physicians' Services in the United States 1948- 1968 (Washington, D.C.: National Center for Health Services Research and Development, 1972); H.S. Luft, Health Maintenance Organizations: Dimensions of Performance (New York: John Wiley, 1981); G.B. Hickson et al., "Physician Reimbursement by Salary or Fee-for-Service: Effect on Physician Practice Behavior in a Randomized Prospective Study," Pediatrics, 80 (1987): 344; and J. Wennberg and A. Gittelsohn, "Variations in Medical Care Among Small Areas," Scientific American, 246, no. 4 (1982): 120-34.
9. See V.R. Fuchs and M.J. Kramer, Determinants of Expenditures for Physicians' Services in the United States 1948- 1968 (Washington, D.C.: National Center for Health Services Research and Development, 1972); H.S. Luft, Health Maintenance Organizations: Dimensions of Performance (New York: John Wiley, 1981); G.B. Hickson et al., "Physician Reimbursement by Salary or Fee-for-Service: Effect on Physician Practice Behavior in a Randomized Prospective Study," Pediatrics, 80 (1987): 344; and J. Wennberg and A. Gittelsohn, "Variations in Medical Care Among Small Areas," Scientific American, 246, no. 4 (1982): 120-34.
10. See V.R. Fuchs and M.J. Kramer, Determinants of Expenditures for Physicians' Services in the United States 1948- 1968 (Washington, D.C.: National Center for Health Services Research and Development, 1972); H.S. Luft, Health Maintenance Organizations: Dimensions of Performance (New York: John Wiley, 1981); G.B. Hickson et al., "Physician Reimbursement by Salary or Fee-for-Service: Effect on Physician Practice Behavior in a Randomized Prospective Study," Pediatrics, 80 (1987): 344; and J. Wennberg and A. Gittelsohn, "Variations in Medical Care Among Small Areas," Scientific American, 246, no. 4 (1982): 120-34.
11. See Newacheck et al., supra note 4; W.A. Ray et al., "Perinatal Outcomes Following Implementation of TennCare," JAMA, 279 (1998): 314-16; and S.M. Retchin et al., "Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care," JAMA, 278 (1997): 119-24. The results of studies examining quality in managed care are mixed, in part because of difficulties in assessing quality.
12. See Newacheck et al., supra note 4; W.A. Ray et al., "Perinatal Outcomes Following Implementation of TennCare," JAMA, 279 (1998): 314-16; and S.M. Retchin et al., "Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care," JAMA, 278 (1997): 119-24. The results of studies examining quality in managed care are mixed, in part because of difficulties in assessing quality.
13. See Newacheck et al., supra note 4; W.A. Ray et al., "Perinatal Outcomes Following Implementation of TennCare," JAMA, 279 (1998): 314-16; and S.M. Retchin et al., "Outcomes of Stroke Patients in Medicare Fee for Service and Managed Care," JAMA, 278 (1997): 119-24. The results of studies examining quality in managed care are mixed, in part because of difficulties in assessing quality.
14. See Friedland, supra note 1, at 101.
15. See C. Lavelle-Jones et al., "Factors Affecting Quality of Informed Consent," British Medical Journal, 306 (1993): 885- 90; and B. Stanley et al., "The Elderly Patient and Informed Consent: Empirical Findings," JAMA, 252 (1984): 1302-06
16. See C. Lavelle-Jones et al., "Factors Affecting Quality of Informed Consent," British Medical Journal, 306 (1993): 885- 90; and B. Stanley et al., "The Elderly Patient and Informed Consent: Empirical Findings," JAMA, 252 (1984): 1302-06
17. See Wickline v. State of California, 239 Cal. Rptr. 810 (Ct. App. 1986); and G.B. Hickson, "Pediatric Practice and Liability Risk in a Managed Care Environment," Pediatric Annals, 26 (1997): 179-85.
18. See Hickson, id. Physicians may need professional assistance with contract negotiations.
19. See W.M. Sage, K.E. Hastings, and R.A. Berenson, "Enterprise Liability for Medical Malpractice and Health Care Quality Improvement," American Journal of Law & Medicine, XX (1994): 1-28. My recommendation differs in that physicians would not be immune from suits while employed or under contract with a health plan. Physicians must remain at risk because their nontechnical behaviors are responsible for prompting the majority of suits. See G.B. Hickson et al., "Factors that Prompted Families to File Medical Malpractice Claims Following Perinatal Injuries," JAMA, 267 (1992): 1359-63; and G.B. Hickson et al., "Obstetricians' Prior Malpractice Experience and Patients' Satisfaction with Care," JAMA, 272 (1994): 1583-87.
20. See W.M. Sage, K.E. Hastings, and R.A. Berenson, "Enterprise Liability for Medical Malpractice and Health Care Quality Improvement," American Journal of Law & Medicine, XX (1994): 1-28. My recommendation differs in that physicians would not be immune from suits while employed or under contract with a health plan. Physicians must remain at risk because their nontechnical behaviors are responsible for prompting the majority of suits. See G.B. Hickson et al., "Factors that Prompted Families to File Medical Malpractice Claims Following Perinatal Injuries," JAMA, 267 (1992): 1359-63; and G.B. Hickson et al., "Obstetricians' Prior Malpractice Experience and Patients' Satisfaction with Care," JAMA, 272 (1994): 1583-87.
21. See W.M. Sage, K.E. Hastings, and R.A. Berenson, "Enterprise Liability for Medical Malpractice and Health Care Quality Improvement," American Journal of Law & Medicine, XX (1994): 1-28. My recommendation differs in that physicians would not be immune from suits while employed or under contract with a health plan. Physicians must remain at risk because their nontechnical behaviors are responsible for prompting the majority of suits. See G.B. Hickson et al., "Factors that Prompted Families to File Medical Malpractice Claims Following Perinatal Injuries," JAMA, 267 (1992): 1359-63; and G.B. Hickson et al., "Obstetricians' Prior Malpractice Experience and Patients' Satisfaction with Care," JAMA, 272 (1994): 1583-87.
22. See J.W Pichert et al., "Understanding the Etiology of Serious Medical Events Involving Children: Implications for Pediatricians and Their Risk Managers," Pediatric Annals, 26 (1997): 160-72. Errors in medicine are most often related to the system of care, not to individual physicians making specific decisions.