Comments on: Defensive Medicine: Cautious Or Costly?

When Doctors Cover Bases By Ordering Extra Tests, It Can Cost Patients Big

[alphaa10-2009]

Patients and Patient Families, Beware!

The medical community for the last decade has been blitzed by little-publicized, traveling "legal seminars"-- these professing to help medical professionals avoid litigation.

As innocent as that sounds, some the methods taught by the seminars are anything but defensive. They cause needless pain and suffering, and are based upon manipulation of patient expectations.

Here is how the methods work. Suppose a patient and his family rush to the hospital for a critical procedure. They are beside themselves with anxiety, and need all the hope and reassurance possible. While emotional comfort sounds like an easy mission for staff, not so fast-- medical professionals are now told, this is "bad medicine".
(See Part 2, below)

[alphaa10-2009]

Part 2-- Patients, Patient Families, Beware!
The attending physician or other managing professional is instructed to inform the patient''s family with a poor prognosis-- "I am sorry, but the outlook is not the best. We''ll do what we can, of course, but it appears all four wheels have fallen off. It will be difficult."

What a blow to an anxious family! What a failure of the oath to do no harm! At hearing such a report, family members have been known to become ill, as a result. But as the seminar tells medical professionals, it is all to the good. They are given the following explanation--

"If you promise the moon, but deliver coal and ashes, you probably will be sued by angry relatives, regardless of the effort you made and difficulty of the case. If you promise little or nothing-- yes, even advise of the worst-- but deliver something, anyway, and maybe even the sun and moon, combined, you will be hailed as a miracle worker. Your fees will be received with gratitude, not scrutiny."

[emh1701]

I have to ask, if it was just a stomach ache, why didn''t anyone tell the kid to just take some OTC stuff and go home and see if it got better first? I don''t know about you folks, but most people can''t afford to go to the emergency room for stomach aches.

I think the media plays up the medical stuff so much that people are freaking out over the smallest things these days.

[scoliosuxs]

The CYA policy is everywhere in medicine today. Not just with the physicians. Social Workers and nurses practice it everyday due to the fear of a lawsuit 5 yrs down the line. It is the first thing they teach the first day of school. Tort reform is desparately needed in this country. It is too easy for someone to sue when they don''t understand the underlying basis of medicine and hospital care. I agree a jury of one''s peers should be those who actually do the same work as you in the medical field. 4 yrs of medicine can''t be taught in a courtroom.

[alphaa10-2009]

Dr_Noshots said, "American citizens are innocent until proven guilty... AMERICAN PHYSICIANS ARE GUILTY UNTIL PROVEN INNOCENT."
---
There is another side to this, of course. The AMA and state medical groups have spent the better part of 50 years in opposition to patient litigation by trial attorneys-- all on the principle, apparently, that the doctor can do no wrong.

Or, if he can, at least that the good doctor should not take responsibility for his every mistake, even when somebody is harmed or dies as a result.

To this end, state and national medical lobbies have pushed for what they disingenuously term "tort reform". Tort reform, in practice, means badgering the state assembly until some bozo takes up the AMA cause. A little money usually helps, and presto! The bill is written to make the physician essentially bullet-proof.

That approach means a patient or his family is sharply limited by what can be recovered when they sue for damages. These damages once included not only pain and suffering, but economic loss, as well. Now, damages may be legally limited ("capped") and not compensate for even medical costs, much less pain and suffering, not to mention economic loss. A tidy bit of self-interest legislation by the medical community, there..

Damage to the patient''s interest, of course, is not the basis of the suit, but medical negligence. Every doctor wants to avoid litigation, but not all doctors try to avoid negligence. Even when someone else''s life depends on it.

[sonotso]

'' ... maybe edible algae and mushroom knick knack artwork could store and possibly even lever or multiply water molecules and microbes ... maybe since we can turn acorns into atomic stars, we can turn acorns into atomic stomachs and forego all the consumption anyways ... ''

[otdky07]

Unfortunately,CT scans are slowly becoming the standard of care. If a physician misses a case of appendicitis, some slick, scumbag lawyer will be salivating at the lips for a chance to sue. Why? Because this is America, where everyone wants to get rich by winning the lottery, only the odds of winning a medical malpractice case are much greater. The physician has to pay his defense, while the plaintiff''s attorney can work pro bono and keep a large chunk of the settlement if they win. Cover your *** is the standard of care in medicine today.

[labourboss]

MRI $1200, CAT SCAN $1,500, PEACE OF MIND PRICELESS!

[dr_noshots]

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 the surgical team, even if they refuse, the only hope for a final diagnosis, AN AUTOPSY (for religious or other reasons), .

[dr_noshots]

For as long a medical liability jury is not a "jury of my peers" who understands medicine, the only way a physician like me can avoid the "doctor, why didn''t you order this test ?" question, is by ordering all possible tests under the sun.

[dr_noshots]

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.

[nerothedog]

What a disappointment on the part of CBS and this report. It would have been more informative to explain what drives ''Defensive Medicine'', rather than describe it as some shortcoming or fault on behalf of doctors and other providers. Defensive Medicine is alive and well in medicine thanks to the constant threat of malpractice lawsuits. A missed diagnosis is one of the most common reasons for medical malpractice litigation in this country. The costs incurred by Defensive Medicine for a patient pale in comparison to the awards associated with cases involving missed diagnoses. The litigation in these cases also results in tremendous stress upon the provider, not to mention a permanent mark on their record even if the case settled and was a baseless, frivolous lawsuit. This in turn usually results in higher malpractice insurance premiums, and the vicious cycle perpetuates. I''m disappointed that CBS provided such a myopic view of a much more pervasive and complicated problem in health care. I would hope that there would be a similar profile on trial lawyers and their role in the exorbitant costs of health care and access to it in this country.

[grammawhamma]

cride1: You are exactly right. I worked at a small hospital as a RN. My husband''s doctor didn''t catch his cancer at a regular checkup and my husband died from the cancer which had spread to his brain five months later. Did I sue...no. The doctor apologized to me over and over but I didn''t and don''t blame him.

Patients have the right to refuse tests but doctors should get it in writing from the patient to prevent lawsuits.

[why_not_nar]

Here is the question though. the average cost of a cat scan is $1000-1,5000 dollars. i had one taken six months ago for $600 dollars. the equipment is expensive but it is amortized, the test itself is given by a technician, so my question is why $6,500 for a test that rarely takes more that 20 minutes. i would strongly challenge the hospital bill.
does medicine have excesses?? yes. too much cosmetic surgery, probably too much surgery in general, but cat scans??, of the problems we are facing this evening overuse of cat scans isn''t one of them. and to suggest that you should ignore pain, and then question each test before it is given, is just plain irresponsible.
i know that ms. couric, who was absent tonight would have led with ''a cat scan for a headache?''. turns out that a headache is often a precursor to a stroke. me..i am glad the technology is available. the lesson is to have long relationship wich doctors who can tell ''what is different'', and doctors that you know well and trust. in a college population of 10 or 15 thousand students, that just is not possible.

[why_not_nar]

dear rick kaplan,
whoa...hang on for a second. first there are a great number of conditions that can be treated if found early and treated quickly. cancer is at the top of that list. does anyone know what percentage of people having tightness in their chest make it alive to the hospital?? under 40%. the point is that pain is something to be understood, not ignored as you suggest. cats scan''s and mri are rarely used indiscriminately. they are both remarkable diagnostic tools.

[cride1]

I don''t blame doctors practicing unnecessary defensive medicine. Why? Because there are so many frivolous lawsuits and the only way for the doctors to protect themselves really is to play it safe no matter the cost. Fortunately, this is a method to shift the cost onto the patient so that they will think twice before going for a frivolous lawsuit.