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According to an article that appeared recently in The New York Times, the politics of doctors may be changing as the mechanics of their practices change. The article notes that historically, doctors were predominately male and owned their own practices. But trends in recent years indicate that more and more doctors are becoming salaried employees of hospitals or HMOs, and the number of women doctors is growing to be about equal to the number of male doctors. Accordingly, some observers have noted that their politics have been moving from right to left.

Why? No conclusive studies have been done but it appears that doctors may be seeing the world more from the perspective of employees rather than business owners. Along with that there appears to be a migration from the Republican Party to more progressive political groups. There is no stronger evidence of this than the American Medical Association’s support for so-called ObamaCare. The reason for the change in the stance on health care reform is believed to that there will be fewer uninsured people seeking care, the health status of patients will improve, and there will be more choice in providers and health insurance. In other words, more doctor focus on public safety and health rather than the bottom line of their practices. Can that be a bad thing?

One group of doctors, however, seems to be bucking this trend. At the recent American College of Emergency Physicians 2011 Leadership and Advocacy Conference, two speakers continued to push for tort reform across the country and offer signs of encouragement and hope. But one speaker offered a different perspective. Peter Smulowitz, MD, FACEP, an emergency physician at Beth Israel Deaconess Medical Center in Boston, noted "The current medical malpractice system is an impediment to patient safety. The status quo is not working."

His pitch? "Disclosure, Apology and Offer." The idea is to be up front with patients and their families when unanticipated bad outcomes occur, to apologize when mistakes are made, and to offer compensation to resolve claims when appropriate. Advocates of the concept note that not every bad outcome is the result of a mistake, but that is already a well understood concept in the area of medical malpractice.

In areas where the concept has been fully implemented, the total number of claims dropped, total liability expenditures dropped by about 60 percent, and the total amount spent on cases that did go to court dropped by 50 percent. In addition, when the system becomes transparent and patients are kept in the loop on what has happened, the focus is more on patient safety and incident reports drop in numbers. Can that be a bad thing?

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