Physicians' complaints that their special status in the eyes of patients is being eroded by changes in healthcare and public attitudes can take comfort that the same thing is happening in Japan, where reverence for doctors is legendary.
That nation's economic troubles have bred mistrust of authority figures, and that has carried over to physician-patient relationships. According to a May 31 article in the Washington Post, more and more Japanese are beginning for the first time to question the medical profession, known as "the last sacred institution in Japan."
Patients' rights advocates are setting up seminars and World Wide Web sites designed to educate people on how to question their doctors-and how to sue them for malpractice.
Because patient records are owned by the physicians or the hospitals, it has been easy for physicians and hospitals to alter them to hide mistakes, Japanese activists told the Post.
Litigation insurance? An Oxnard, Calif., attorney renowned for winning large civil verdicts against HMOs now says he wants to help their provider networks.
Mark Hiepler's firm, Hiepler & Hiepler, is offering free consultations to hospitals, neonatologists and pediatric ophthalmologists that do business with HMOs. Hiepler's goal: to establish guidelines for examining and treating premature infants suffering from retinopathy.
"These simple exams may be all it takes to prevent blindness and prevent the need for lawsuits against HMOs, their physicians and hospitals," Hiepler said in a written statement. "I hope that the fact we are willing to do this as a free service will attract . . . groups that need to be educated and who would normally be our opposition."
Hiepler is no friend of HMOs. He recently won a $6.8 million verdict for a 2-year-old client he says was blinded through the negligence of an "HMO-supplied medical director." He also won a landmark $89 million verdict against HealthNet in 1993 for its failure to provide a bone marrow transplant for his sister, Nelene Fox.
Industry observers say it's not uncommon for attorneys to offer a vague form of insurance against litigation in the guise of medical advice. But the head of California's HMO lobby isn't moved by Hiepler's gesture.
"He can offer whatever advice he wants to whomever he wants," says Walter Zelman, president of the California Association of Health Plans. "If he tells HMOs this is what they would get sued for down the line for $10 million, then he's offering a valuable service. But I doubt he'd get a lot of business from them."
After gnarly break, indigent dude wins. The Idaho Supreme Court has ruled that Bonner County, Idaho, illegally refused to grant a medical indigency claim by a ski bum who broke his leg on a local mountain.
The five-member high court upheld a state district court judge's reversal of the county's ruling that Jason Todd Foy's lifestyle choices were to blame for his inability to pay. Those choices include skiing, mountain bike racing and hanging out with his buddies, county officials say.
Foy, 19, was treated at Bonner General Hospital in Boise, Idaho, running up almost $15,000 in medical bills.
He had only minimal income-having just been hired for a job paying $4.25 per hour-a sketchy employment history, no real assets and no medical insurance at the time of his accident. So he filed a medical indigency application seeking to have his medical bills paid by Bonner County, which was rejected.
Harsh, the court in effect said. "Foy's minimal income could not retire his medical debt within three years regardless of what 'lifestyle choices' he might make," Justice Jesse Walters wrote in the Supreme Court's decision rejecting the county's case.
Ticked in Georgia. Medical College of Georgia is seeking "100 people who emerge from outdoor activities with a tick attached . . . for a study on the best way to remove the tick and reduce their risk of tick-borne infection."
Ticks can cause Lyme disease, Rocky Mountain spotted fever and ehrlichiosis. Michael Felz, M.D., a family physician at MCG, sought to recruit the tick-infested patients through an unusual press release. He's offered to extract the tick free of charge and tell patients which particular variety of Ixodoidea Acarina has stuck a blood-sucking hypostome into them.
Felz will compare removal of the tick or ticks by tweezers with a commercially available device called Ticked Off.
Healin' the blues. It is fitting that a clinic devoted to caring for indigent musicians should be located in New Orleans, birthplace of jazz and the blues.
The New Orleans Musicians' Clinic has been open for a year on Wednesdays in space provided at no cost on the fifth floor of Louisiana State University Medical Center.
A recent patient is "swamp bluesman" Coco Robicheaux, who warily entered the sterile glass-and-concrete environs in a straw hat with a beadwork band clutched in his hands like a security blanket.
Robicheaux, 51, says he hadn't had a checkup for 30 years, ever since the Army rejected him because of an irregular heartbeat. "My policy was ignorance is bliss, and there were financial considerations; I thought checkups were a luxury for wealthy people," he says. He was pronounced "in pretty good shape," by Carol Schwaner, a family nurse practitioner who is the clinic's coordinator.
She says the clinic has logged about 250 patient visits in its first year and grown increasingly popular. Musicians pay $10 for the first visit and, afterward, pay on a sliding scale according to their means.
The clinic, one of the few of its kind in the country, has three sponsors, says Johann Bultman, one of its organizers: Louisiana State University Healthcare Network, which comprises LSU Medical Center's teaching staff and provides the medical volunteers; the Daughters of Charity Services of New Orleans; and the New Orleans Jazz and Heritage Foundation.
So far, the clinic has survived on about $100,000 in donations from individuals and groups, money that goes to pay for medical tests and lab costs.