The 1,100 attending the Catholic Health Association's annual conference in Chicago had a chance to replicate an "American Idol" audience and vote for their favorite choices. Only instead of punching in a young talent of choice, the audience registered electronic answers to multiple-choice ethical dilemmas.
After viewing videotapes of fictitious healthcare encounters on large screens, about 950 of the audience members used keypads to respond to ethical questions regarding what they had seen. The percentages for each of the four choices were tallied within minutes and flashed on the screen, just like on TV. However, these fans were more fickle, as befitting the gnarly questions posed by ethical quandaries. After listening to a panel of ethicists debate the issues, the audience changed its vote several times.
For example, 51% of the audience agreed that an outpatient physician clinic should treat patients regardless of their behavior, even if they seemed unwilling to participate in their care, while only 33% voted that it was appropriate for clinics to require patients to take some responsibility for their care and sign behavioral contracts agreeing to take their medicine and follow physician advice.
After hearing from theologian and medical ethicist the Rev. Thomas Kopfensteiner; physician James Scott; moderator and medical ethicist Sister Patricia Talone; and Sandra Bruce, president and CEO of 355-bed St. Alphonsus Regional Medical Center in Boise, Idaho, only 36% of respondents agreed that the clinic should treat patients regardless of their compliance efforts and 44% thought clinics were justified in requiring behavioral contracts. The audience seemed surprised by its change of heart. The panelists, steeped in the ethical minefields of healthcare decision-making, were not.
The arguments often boiled down to the vexing question facing most healthcare providers, Catholic or otherwise: how to best care for difficult- to-manage patients with limited resources, or margin vs. mission.
"The fact is, you can't always afford to do the right thing," Scott says.
Going down swinging
As Outliers predicted last week, South Carolina surgeon J. Chris Hawk didn't win a lot of support at the annual American Medical Association meeting for his novel approach to handling the malpractice crisis: He asked the doctors' group to endorse the notion that physicians should deny anything but emergency care to plaintiffs' lawyers and their spouses.
Indeed, at least partly because of a flood of publicity, Hawk withdrew his proposal before it even came to a vote, saying his "infamous resolution" had accomplished its goal of high-lighting the malpractice crisis by gaining attention that ranged from "Nader to NPR."
"It got the attention of plaintiffs' lawyers," Hawk told fellow delegates during the AMA's annual meeting last week in Chicago, just before withdrawing his controversial motion. "It gave voice to the frustrations all of us feel that our AMA has been politically correct (on tort reform)."
Though an AMA delegate derided Hawk's proposal, saying it would be "interpreted as a sign of pettiness and vindictiveness" by physicians, his tough tactics have been adopted by other doctors, including a plastic surgeon in Jackson, Miss., who earlier this month refused to treat the daughter of a state legislator who has opposed limits on noneconomic damages in malpractice lawsuits.
As for Hawk, he wasn't exactly backing down from his proposal. "The first thing we do, let's kill all the lawyers," he told AMA delegates. "I say this as a joke. (The resolution) is my compromise position."
AHIP against the wind
Talk about ambition. Undeterred by the partisan gridlock in Washington and an oversaturated market for advocacy advertising, America's Health Insurance Plans has launched a print ad campaign to persuade lawmakers to adopt its ambitious healthcare agenda this year. It also hopes to build grass-roots support later this year in 17 electoral battleground states.
"The conventional wisdom is that nothing happens in an election year, but we believe we can get traction on some of these issues this year," says Karen Ignagni, AHIP's president and CEO.
The "50-50 Nation?" ads, which are running in Washington's many political publications, cite data from an April survey that AHIP commissioned of 1,000 voters in the 17 states considered "at play" in the presidential election. The survey found a majority of respondents believe the healthcare debate has been too partisan and that far from being evenly split on the issues, they coalesce around several concerns. Those are that the medical liability system favors trial lawyers at the expense of patients, that evidence-based medicine must be adopted and that tax-free health insurance options are a good idea. The survey also found greater support for privatization of Medicare than other surveys have found.
"Our polling shows that there is broad agreement on a range of key healthcare issues. We intend to make sure Washington opinion leaders hear that message loud and clear," Ignagni says.
Given that Congress seems more preoccupied with scoring political points on last year's big battle, Medicare reform, Outliers wishes AHIP luck. It will need it.
"This is not a blacklist; it's a sunshine list."
-Dennis Agliano, a physician from Tampa, Fla., during debate at the AMA's annual meeting last week on a resolution that called for the association to fund a national Internet listing of doctors who testify against other doctors in medical malpractice cases. The proposal failed.