PRESIDENT'S MESSAGE
Mark Lopatin, MD

PAST PRESIDENT'S MESSAGES- ARCHIVES

On June 2, 2009, Mark Lopatin, MD, a Rheumatologist from Abington Pennsylvania, was elected and installed as the 162nd President of the Montgomery County (PA) Medical Society. The following is a transcript of Dr. Lopatins's Installation speech.



Mark Lopatin, MD
162nd MCMS President
Mark Lopatin, MD-162 MCMS President

Thank you all for coming. I am honored to be here, but the real reason I am here is that I am a die-hard Eagles fan, and I wanted to hear Vince Papale. Nonetheless, I have been asked to say a few words. My wife is a little nervous right now, because it’s not often I am given a soapbox and well, let’s just say I will try to get you all home before the weekend.

There are many issues in medicine today. Those of you that know me know that tort reform has always been my #1 issue. There is some good news in this area based on a recent article in the Philadelphia Inquirer which suggests that the malpractice crisis is resolved. It notes that the number of malpractice cases has decreased by 54% in Philadelphia. (We’ll ignore the 283% increase since 2001 in Montgomery County). Furthermore, malpractice premiums have gone down or stayed the same for 3 consecutive years. Governor Rendell has stated that measures taken since 2002 “have been extraordinarily impressive in abating the malpractice insurance crisis,"

I was recently at a medical legal meeting when an attorney informed me that malpractice is not a driver of the high cost of medicine as malpractice premiums account for < 1% of health care costs. Basically, I was told that malpractice is a non issue

Well, the situation may have improved, but I would argue vehemently that there continues to be a serious malpractice problem which is measured not by malpractice premiums, the number of cases filed, or the number of physicians leaving the state, but rather by the way we practice medicine. The key phrase is defensive medicine and it hurts patients

Defensive medicine is defined as providing medical services that are not expected to benefit the patient but that are undertaken to minimize the risk of a subsequent lawsuit. Defensive medicine results in an overuse of technology, an overuse of specialists and an overuse of the ER. These things cost money and use resources. End result – increased Health Insurance premiums and decreased access to care, which just happen to be the 2 biggest issues in health care today. In one recent survey, 93% of physician respondents in Pennsylvania stated that they practice defensive medicine. A study by the Massachusetts medical society in 2008 noted that ~ 25% of imaging studies were ordered for defensive reasons. The actual cost of defensive medicine is very difficult to measure, but several estimates place it at > $100 billion/ year. Stuart Weinstein, a former president of the American Academy of Orthopedic Surgeons states that “excessive litigation and waste in the nation’s current tort system imposes an estimated yearly tort tax of ~$10,000 for a family of four. Although we can’t really verify these figures, it is safe to say that the cost is huge. And that does not even include the inconvenience, and anxiety that invariably accompany defensive medicine.

Why the problem. The major problem is a society that has been led to believe that we can have it all, unlimited health care for the individual and access to health care for all at minimal cost with no risk. I saw a billboard a few weeks ago, that said “You deserve the best dialysis care available”. It didn’t say, we provide the best dialysis care available. It said “YOU DESERVE”. Lawyers’ ads state, “We will get you the money YOU DESERVE.” “You DESERVE”. Think about the meaning of those 2 words. No wonder the American public is dissatisfied with health care. We have created a culture of entitlement such that reality cannot meet the expectations that WE DESERVE. The needs of the individual are in a delicate equilibrium with the needs of the community. We can’t satisfy one without sacrificing the other. We can’t have both and keep costs down

A corollary to the culture of entitlement is the culture of blame. Everything is always supposed to go well, (After all, we DESERVE it). If it doesn’t, it must mean that someone screwed up and they should pay. Well, a bad outcome is not the same as an honest mistake is not the same as an egregious error. This distinction is critical. The use of certificates of merit has helped in this regard, but they are currently provided by physicians handpicked by attorneys. I would like to see certificates of merit be provided independently. If we want to police ourselves, let’s make it mandatory for licensure that doctors must review potential lawsuits to determine their merit. This would keep the certificates of merit out of the hands of “the hired guns” and make them a better measure as to the validity of a case.

Furthermore, we need to change the way we resolve our conflicts. Even the language in a lawsuit is hostile. In a lawsuit, a doctor does not simply make a mistake; he acts with gross negligence and reckless and wanton disregard for his patient. As adults, why can’t we resolve our conflicts in the same ways that we would teach our children to resolve them, with apologies, compromise, forgiveness and handshakes? This does not mean that doctors should not be held accountable, nor does it mean that patients should not be compensated. It does mean that we can and should try to resolve conflicts without the current hostility inherent in the system.

To this end I have been fortunate to serve as chair of the Montgomery County Mediation Task Force. This committee was made up of members of MCMS, Montgomery Bar Association, representatives from AMH and a consulting firm, Health Care Resolutions. Through this committee, a pilot program was set up at Abington Hospital to explore early disclosure and formal mediation as a better way to resolve conflicts. The program has been in place for a little more than a year, and so far the results look promising. It is hoped that this program can be expanded to other venues, so that when conflict occurs, the goal becomes mutual understanding and fair resolution and not revenge.

The only way to do this is through education, one patient at a time, one doctor at a time, one legislator at a time. That requires all physicians to be involved. The load cannot be carried by a few. The Medical Society can act as a microphone, but if there is no one standing behind it, our voices will not be heard. I challenge each physician here to speak out. Educate your patients. Contact your legislators. Let them know what is going on. Make a difference. Encourage your colleagues to follow suit. Be an advocate for your patients. Remember as much as we talk about this being a doctor issue, in truth it is a patient issue. Patient care is being compromised. I know that this is not the only time I will be standing on this soapbox in the coming year. I urge you to join me in this regard. My soapbox has lots of room for others.

As always at an event like this, there are plenty of people who deserve acknowledgement. I do wish to recognize Toyca Williams, executive director of MCMS and Christine Mccloskey southeastern PA field rep for PMS. They work tirelessly behind the scenes and rarely get the recognition, they deserve. I would like to publicly applaud them for their efforts.

I would like to thank the board of directors for their leadership and dedication. I wish I could thank them all individually tonight. I want to thank my coworkers at Rheumatic disease Associates for their support; many of them are here tonight,

I also would like to thank my family, my mom Barbara, my brother Rick, his wife Sharon and her parents Stan and Char for being here to share this evening with me.

Finally my wife Suzan and my daughters Dana and Melanie. They have certainly had enough evenings without me while I attend meetings, yet they are willing to put up with me in this current role, recognizing there will be many more nights in the future that I will not be home for dinner.

I can now put the soapbox away, but rest assured, I have it handy for when I need it. I look forward to serving you this coming year. I thank you all for coming tonight

Mark Lopatin, MD,
President, Montgomery County (PA) Medical Society


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