Defensive Medicine: Do I Need This Test?

By: Wyatt Andrews
Topics: Field Notes

(CBS)

Wyatt Andrews is a correspondent for CBS News based in Washington.

Sometimes, my own, actual life bears a resemblance to what I cover.

This very morning, by coincidence, my doctor sent me to have a c/t scan, (cat scan) to help diagnose a minor pain which I keep complaining about but which he can't figure out. Cat scans, which typically cost several thousand dollars, are often cited as the key example of what's called defensive medicine: the practice of ordering too many tests or medical procedures "just to be sure" of a diagnosis. The costs of defensive medicine are likely in the ten of billions of dollars, but what are we are patients supposed to do? Should I have questioned such an expensive test? To save (CBS's) money, should I have asked for an x-ray instead?

Tonight's story, which is on the nationwide practice of defensive medicine, focuses on the case of a Richmond college student who went to the emergency room with stomach pain and (guess what?) was immediately given two cat scans.

She had a harmless ovarian cyst, but her father had a near stroke. He got an $8,500 bill -- most of which, $6,500, was for his daughter's two cat scans. The hospital defends the test, saying they had to rule out other complications, such as a kidney stone. But the student's father, who is also a physician, could have and should have found her cyst with a thousand dollar ultrasound.

However you judge this particular case, defensive medicine adds billions to the costs of health care, in unneeded imaging tests, diagnostic tests and surgeries. Too often, it's not about having an extra test "just to be sure;" the doctor is ordering extra tests to protect against being sued.

Several health care experts say there is a list of questions to ask your doctor to help screen the necessary from unnecessary procedure.

1) Why is this test needed?
2) Is there an alternate test that's less expensive.
3) Could the results of this test really change my diagnosis or treatment?
4) What's the risk if I decline the test?

You have a right to ask: Did I ask these questions before I got my own cat scan? Honestly? I asked two of the four, question 1 and question 3, essentially because I really want to know this pain isn't serious. (We'll know by Friday.)

Skeptics say we will never truly reform defensive medicine -- that we have to cap damage awards from malpractice lawsuits first -- because of this critical point: a test what might be defensive and unnecessary in one patient, might also help or save the life of another.

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by dr_noshots October 24, 2007 3:57 PM EDT: As an allergic reaction to Defensive Medicine, I was thinking on becoming an Executioner. After all, in the post-electric chair era, who knows better than an anesthesiologist how to administer intravenous drugs ?

But, as all American doctors are, I am obsessed by the possible legal implications of such choice. What happens if "the patient" survives ?

DO I HAVE TO BUY EXECUTIONER MALPRACTICE INSURANCE ?; Reply to this comment


by dr_simmons October 24, 2007 3:00 PM EDT: I have found your series on Defensive Medicine interesting and informative. Two things strike me regarding it''s presentation however. Does anyone really think one can question one''s Doctor and get straight answers as to risks and decision alternatives? If you are right, the Doctor''s interest is the avoidance of such testimony. Second, and I admit here I have some proprietary research to guide this comment: the over - prescription of tests may have nothing to do with the patient- Doctor assessment process. Rather it may be due to the economics of medicine under current conditions. We are faced as a nation with a medical community ramped up to serve at a considerable cost which is experiencing a major drop in demand because of a rapidly declining base of insured patients to treat. The over-prescriptions, and perhaps over-recommendation of procedures, could be driven by the need for capacity utilization rather than concern for the patient. To test my point, see if you can find a frequent story of defensive medicine practiced on street people; else your hypothesis of what is going on may only be partially correlated with reality.; Reply to this comment


by dr_noshots October 23, 2007 11:59 AM EDT: The Non-Hypocritic Oath

I swear:
To obey the law and practice medicine to the best of my knowledge and according to my local judges, medical malpractice lawyers, jury decisions, mandatory second opinions, liability insurance companies and HMO limitations.
If abortions remain legal, I will or I will not produce them, depending on my own personal beliefs, on the number of abortion clinics burned in my immediate vicinity, and on the number of anti-abortion people picketing the local hospitals.
I will give no deadly medicine to anyone if asked, nor suggest any such counsel. Unless, of course, a euthanasia law is finally passed and I will then make such desperate decisions case by case.
Whatever in connection with my professional practice, or not in connection with it, I see or hear, in the life of men or women which ought not to be spoken of here or abroad, I will not divulge, as reckoning that all such should be kept secret.
Unless of course, their charts are subpoenaed by medical liability attorneys, requested by Medicare or Medicaid, checked by the hospital peer review committees or investigated by the department of Health.
While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the Art of Defensive Medicine.; Reply to this comment


by dr_noshots October 23, 2007 11:38 AM EDT: Contingency fees hungry attorneys claim that professional peers are already allowed in jury cases-- they are called expert witnesses.

Expert witnesses are exactly that: WITNESSES. They don''''t take part in the legal decision. And the carefully selected juries don''''t always understand the pathological facts.

Do you want to be rejected from jury duty in a medical liability case ? Just tell them your spouse or your best friend is a physician. It happened to my wife.; Reply to this comment


by dr_noshots October 23, 2007 11:09 AM EDT: Suing and collecting from physicians who did nothing wrong, IS EASY:

http://www.americanauthorsassociation.com/Book%20Review-TerrO.R.%20-%20Neuschatz.htm; Reply to this comment


by dr_noshots October 23, 2007 12:17 AM EDT: Re "RES IPSA LOQUITUR."
I forgot to emphasize a point: the family of a "cardiac arrest on the O.R. table" patient is allowed to sue to the surgical team, even if they refused an autopsy (for religious or other reasons).; Reply to this comment


by dr_noshots October 22, 2007 11:59 PM EDT: RES IPSA LOQUITUR (or Why I Wrote "terrO.R.").

If a person dies suddenly in a hotel room, the initial diagnosis is "heart attack."

If a person dies suddenly in an operating room, the initial diagnosis is "anesthetic death."

American citizens are innocent until proven guilty. In murder cases, it is up to the police and to the prosecutor to prove that the murderer is the killer.

AMERICAN PHYSICIANS ARE GUILTY UNTIL PROVEN INNOCENT.

Why ? Because of the RES IPSA LOQUITUR doctrine (a Latin phrase which means: "the thing speaks for itself"). In other words: the patient was alive before the medical services and dead after them . Could the good doctor prove his or her innocence?

But physicians are never invited to sit on a medical malpractice "jury of your peers" and, believe me, health care innocence is hard to prove in front of carefully selected non medical jurors. Raising "medical liability insurance" fees is simpler. Much simpler. The 2007 professional insurance for a Long Island neurosurgeon is $309,311 ! Would you encourage your child to become one ?

BUT PHYSICIANS ARE NOT ALWAYS GUILTY AND "terrO.R." IS HERE TO PROVE IT.; Reply to this comment


by dr_noshots October 22, 2007 11:55 PM EDT: For as long as a medical liability jury is not a "jury of my peers" who understands medicine, the only way a physician can avoid the "doctor, why didn''t you order this test ?" question, is by ordering all possible tests under the sun.; Reply to this comment


by ericolet October 22, 2007 10:12 PM EDT: Mr. Andrews:
Your healthcare segment caught my attention tonight. What''s interesting with patients, after the fact, is that they have a tendency to complain especially when results indicate nothing significant. What if a critical ailment gets overlooked because one chose to go with the cheaper option? Interesting to note that people who go to games never complain about the outrageous prices of game tickets such as, baseball and football! Thanks for the time.; Reply to this comment

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