Re: Insurance 'recommendations' for practice
From: Charlie Chambers (ricechaz@earthlink.net)
Thu Jul 20 19:20:42 2006
You'd think that as much sentiment as we have against ACOG, a
competing organization would form. Any other national organization
would work to protect the job environment of its members. It would
strive to help us in our many crises, liability, 3rd party payors,
repetitive credentialing procedures, policing its members. What we
get our bulletins that usually hamstring our daily lives or worse
have no direction at all.
Sorry, just venting. I'm tired of the academicians merely building up
their CV's at no benefit to the majority rank and file members.
On Jul 20, 2006, at 4:41 PM, Gordon Goldman wrote:
> Can I have some of the stuff you are smoking??
>
> Gordon M. Goldman, M.D., FACOG
> Chair, Missouri Section, ACOG
>
> -----Original Message-----
> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
> Efrain
> Ramirez
> Sent: Wednesday, July 19, 2006 6:43 PM
> To: Multiple recipients of list OB-GYN-L
> Subject: Re: Insurance 'recommendations' for practice
>
> I sure hope ACOG will take a strong stance against this policy..
>
> Ef
>
>> At Wed, 19 Jul 2006, Lynn Montgomery, MD wrote:
>>
>> Ef,
>> I sent an e-mail briefly outlining the issue and asked for
>> direction on who
>> to contact in an "official" capacity at ACOG. Haven't heard
>> anything back
>> yet.
>> Lynn
>>
>> -----Original Message-----
>> From: ob-gyn-l@obgyn.net [mailto:ob-gyn-l@obgyn.net] On Behalf Of
>> Efrain
>> Ramirez
>> Sent: Wednesday, July 19, 2006 5:26 PM
>> To: Multiple recipients of list OB-GYN-L
>> Subject: Re: Insurance 'recommendations' for practice
>>
>> Amazing..
>>
>> Lynn may I forward this to ACOG's Liability Forum?
>>
>> Ef
>>
>>> At Wed, 19 Jul 2006, Lynn Montgomery, MD wrote:
>>>
>>> Listers,
>>> I am pissed and I apologize in advance because y'all are my closest
>>> sounding board...
>>>
>>> I received a booklet in the mail from the medical malpractice
>>> insurance
>>> company that covers most of us in Montana. The booklet is titled,
>>> "Insurance Recommendations for Obstetrical Practice". Under the
>>> title
>>> on the cover page is says, "There are only two options for
>>> delivery: An
>>> easy vaginal delivery or an easy cesarean section".
>>>
>>> The booklets starts off by making the following statement,
>>> "Failure to
>>> abide by the insurance recommendations in the absence of the
>>> patient's
>>> written consent will not affect coverage provided under a policy
>>> then
>>> in effect, but may result in non-renewal of the policy or renewal
>>> with
>>> an exclusion of the coverage for obstetrical care".
>>>
>>> The booklet then lists basically all types of obstetric
>>> management and
>>> situations and provides very matter of fact direction on how each of
>>> these situations should be managed. Dictums are provided - no
>>> acceptable alternative, one way, period. Further, the booklet
>>> contains
>>> NO references or bibliography.
>>>
>>> Some examples of the "recommendations"
>>> -"it is inappropriate to discuss serum screening in terms of
>>> "false
>>> positives". Rather this should be offered to all pregnant women in
>>> order to determine whether or not they are at increased risk for
>>> Down's
>>> syndrome, and the absolute magnitude of this risk."
>>>
>>> -"cesarean section is almost always the appropriate route of
>>> delivery for lack of progress in labor, unless criteria for
>>> outlet forceps
>> are met."
>>>
>>> -"all singleton breech fetuses (24+ weeks gestational age) should
>>> be delivered by cesarean section."
>>>
>>> -"VBAC - Elective induction is contraindicated. The only
>>> acceptable oxytocin regimen is a starting dose of 1mU/min,
>>> increasing
>>> by 1 mU every 30 minutes."
>>> The following quote is included, "Remember that most cases of
>>> uterine rupture will be heralded by the appearance of new,
>>> significant
>>> variable decelerations. A low threshold for intervention in the
>>> presence of such decelerations, even with good variability and
>>> accelerations, in mandatory in the VBAC patient".
>>>
>>> -"When misoprotol is used with a living fetus, which is
>>> potentially
>>> viable exutero, the following precautions are mandatory:
>>> The dose is 0.25 mcg vaginally
>>> The dose cannot be repeated more frequently than every 4
>>> hours
>>> Elective induction with misoprotol is contraindicated"
>>>
>>> These are only a very few examples of the mandates listed on 25
>>> pages.
>>> I am personally offended by the fact that an insurance
>>> organization, to
>>> whom I pay thousands of dollars in premiums is providing
>>> mandates, not
>>> suggestions, on the management of patients that I trained to care
>>> for
>>> over many years of residency, fellowship and practice. Further,
>>> it has
>>> been beat into me by every mentor worth his/her salt that management
>>> should be based on review of the most current literature. Many
>>> of the
>>> recommendations included in this booklet are not necessarily
>>> substantiated by our body of literature, but rather based on
>>> legal case
>>> history. As such, we are being coerced into practicing medicine
>>> based
>>> on law rather than medicine. I was further personally offended
>>> by the
>>> fact that a booklet like this is issued without the inclusion of
>>> references or bibliography - probably because most of it would be
>>> referenced in West Law. It is time that the fricking attorneys
>>> stayed up
>> watching a tracing at 2:00 am like I did last night.
>>> Lynn
>>
>> --
>> " The greatest obstacle to knowledge is not ignorance, it is the
>> illusion
> of
>> knowledge." Daniel J. Boorstin - Historian
>>
>
> --
> " The greatest obstacle to knowledge is not ignorance,
> it is the illusion of knowledge." Daniel J. Boorstin - Historian
>
