Defensive Medicine: Cautious Or Costly?
When Doctors Cover Bases By Ordering Extra Tests, It Can Cost Patients Big
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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.
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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)
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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.
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Couric & Co. Blog: Do I Need This Test?
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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 ?
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 !)
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.
http://www.americanauthorsassociation.com/Book%20Review-TerrO.R.%20-%20Neuschatz.htm
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?
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.
"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.
http://www.americanauthorsassociation.com/Book%20Review-TerrO.R.%20-%20Neuschatz.htm
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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.
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.
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