Defensive Medicine: Cautious Or Costly?
When Doctors Cover Bases By Ordering Extra Tests, It Can Cost Patients Big
-
Play CBS Video
Video
Too Many Medical Tests?
Fearing malpractice lawsuits, many doctors are practicing defensive medicine, ordering unneeded, expensive tests. The higher health care costs are often passed to the consumer. Wyatt Andrews reports.
-
Photo
When Alexandra Varipapa, a sophomore at the University of Richmond, had a stomach ache that persisted, she decided to go to the emergency room but she underwent a CT scan that some would call unnecessary. (CBS)
-
Interactive
HealthWatch
Explore health issues including AIDS, cancer and antibiotics.
-
Quiz
Medical Exam
Give your brain a checkup with these health quizzes.
There, doctors ordered a full CT scan, a radiation imaging test, which found a harmless ovarian cyst. She never questioned the CT scan, CBS News correspondent Wyatt Andrews reports.
But her father did - when he got the $8,500 bill, $6,500 of which was that CT scan.
“I was pretty flabbergasted,” said Robert Varipapa, himself a physician.
Varipapa says his daughter's pain could have been diagnosed far more easily and cheaply with a $1,400 ultrasound.
“A history, a pelvic examination and probably an ultrasound,” he said. And he would have started with the ultrasound.
But the hospital defends the CT scan, saying an ultrasound might have missed something more serious.
“It would not have ruled out appendicitis obviously, it would not have ruled, necessarily, out a kidney stone,” said Dr. Bob Powell, ER medical director of Bon Secours St. Mary’s Hospital.
Varipapa agrees, but asks why not start simple - and do the CT scan only if necessary?
“Well it's my opinion this is defensive medicine,” Varipapa said.
Defensive medicine is what happens when doctors order too many tests because they are afraid of missing a diagnosis and later losing a multi-million dollar lawsuit for malpractice. Defensive medicine these days is so pervasive, some estimate its yearly cost at more than $100 billion.
Dr. Kevin Pho runs the popular medical blog, Kevin M.D., where doctors routinely confess exactly how they run up costs by practicing defensive medicine.
“Defensive medicine is bad medicine,” Pho said.
In a post, one ER doctor says he's just admitted two patients to the hospital - when he was sure "neither was having cardiac (problems), but what am I to do?"
Another admits that in his practice, “every patient with a headache gets a (CT) scan.”
“It's much easier to defend the fact that you ordered a test than it is to not order the test at all,” Pho said.
And the costs of defensive medicine today are increasingly paid by patients, even those with insurance - because of rising deductibles and co-payments.
“There’s no doubt in my mind this is a significant driver in health care costs today,” Pho said.
But there are ways the patient can sort out the necessary from the unnecessary tests.Couric & Co. Blog: Do I Need This Test?
Experts tell CBS News you should ask basic questions.
First: Why is this test needed? Ask about the cost and if there's a less expensive, alternate test. Ask if the test results might change your diagnosis - or treatment. And, "what is the risk if I don't have the test?"
“They didn't really talk to me about doing anything else,” Alexandra Varipapa said.
In Varipapa's case, the hospital insists her CT scan was medically required, given her symptoms.
But in the end, the hospital did present an $8,500 dollar bill - for a condition that went away on its own.
© MMVII, CBS Interactive, Inc. All Rights Reserved.
Video and Galleries from CBS Evening News
- Latest in CBS Evening News
- National Mall Showing Its Age
- Fans Clamor for Jackson Memorial Tickets
- America's First Conservationist
Couric & Co. Blog: Do I Need This Test?



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.
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.
Patients have the right to refuse tests but doctors should get it in writing from the patient to prevent lawsuits.
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.
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), .
---
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.
I think the media plays up the medical stuff so much that people are freaking out over the smallest things these days.
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."
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)
Medicine as practiced currently needs to be changed and MEDICINE and Particularly Pharmaceuticals with their Adds pushing Medicines hoping to claim a portion of the Money and all they can Grab.
REP Dinners, gifts, Incentives, they are totally out of control and Their Millions BUY allegiance from many physicians and even entire clinics who use their Money to expand and push prophets even further upward as costs continue to spiral.
---
But a courtroom exists to establish that underlying basis. If it can be taught to you, it can be presented to others, as well. Should people no longer have the right to sue for justice in medical cases, simply because you fear they may not agree with you?
In any event, the tort reform you suggest has nothing to do with proper understanding of the merits of a case. Its sole purpose is to isolate and limit the ability of a jury to decide what is just. Tort reform is an effort to limit legal recourse.
Put another way, if only technical practicioners have the facts and know the truth, how could they be held accountable under law for their actions? Some medical professionals do not seem worried by that prospect.
Professional peers are already allowed in jury cases-- they are called expert witnesses. Medical professionals who are not satisfied with this approach seem to want a "tribunal", a closed-session adjudication similar, perhaps, to the disciplinary procedures of a medical associaton. In other words, "We''ll handle this in-house. The public need not inquire further."
This would place medical malpractice above the law.
http://www.americanauthorsassociation.com/Book%20Review-TerrO.R.%20-%20Neuschatz.htm
"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.
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.
Thats pretty amusing, and sadly true. I think alot of MDs are gun shy of people who may sue them for malpractice. And then they tend to go over board in the assessments of their patients.
Defensive medicine..very cute. We just have to protect our license, right?
http://www.americanauthorsassociation.com/Book%20Review-TerrO.R.%20-%20Neuschatz.htm
This is one reason why our health insurance premiums are outrageous. Most doctors are probably competent to diagnose a condition within their specialty. The use of high priced testing equipment is not required on a routine basis. It''s revenue builder. Don''t let them do it to you. Just say "no"! Don''t go to the doctor for annnual physicals and routine visits urged by the physician. Go when you are sick or hurt.
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.
(Sorry but....it had to be repeated !)
-
by dr_noshots
October 24, 2007 12:56 PM PDT
- 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 ?
-
Reply to this comment
-
See all 36 CommentsBut, 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 ?