Treating conjunctivitis using defensive medicine

June 13, 2005

The fourth part of this continuing series. Defensive medicine isn’t all about ordering more tests. A reader writes about this recent telephone conversation:

Patient
I have a red eye for about 1 day and awoke with crusty discharge. My son has recently been diagnosed with conjunctivitis and is on antibacterial ointment.
Doctor
Any trauma to the eye, visual changes or light sensitivity?
Patient
No. Can you prescribe something over the phone?
Doctor
We have a strict policy where every patient has to be seen prior to prescribing medication.
Patient
That’s ridiculous. I’ve had bacterial conjunctivitis before, and my symptoms then were identical to this. Besides, you’ve prescribed antibiotics for me over the phone in the past.
Doctor
The symptoms certainly sound consistent with conjunctivitis, but without examination it is impossible to be certain. Unfortunately, the clinic is closed today, so you may have to go to the emergency room for evaluation.
Patient
What!? I’m NOT waiting 5 hours in the ER for a simple conjunctivitis. Why can’t you call something over the phone?
Doctor
Unfortunately, due to today’s liability climate, we have a strict policy of not treating patients over the phone – no matter how small the problem is. If you’re not comfortable with this policy, you are welcome to change practices.
Patient
Unbelievable! I think I may just do that. (hangs up)
I may have lost a patient, and drove up costs by advising a probable conjunctivitis to go to the ER, but at least there is zero possibility of being sued over this. It’s a trade I’ll make every time.

Defensive medicine is one of the leading factors in driving up health care costs today. The purpose of this series is to breathe some real-life examples into the numbers, and to provide some insight into how the threat of malpractice litigation pervades medical decision making.

Please e-mail me your stories of “how you practiced defensive medicine today”, and it will be posted anonymously as part of this continuing series.

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1 Anonymous July 6, 2005 at 8:40 am: In case anyone wants some insight from a partner in medical malpractice defense in NYC…
More than 50% of malpractice is caused by less than 1% of doctors.
Medical malpractice insurance is primarily set to go up or down with the stockmarket because insurance payments are invested. Low stock market = higher insurance rates.
If we could get rid of lousy doctors and have a robust stock market, insurance would certainly be manageable.
That said, defensive medicine certainly has some relationship to insurance rates. The important question is whether this is right. The problem with treating over the phone is that there is always a chance of misdiagnosis. If you think the patient should accept this slim risk, this would lower insurance rates a little bit.
On another note, yes there are many frivilous law suits. They rarely, if ever, succeed. My firm frequently sees them and frequently gets them dismissed. This still costs several thousands $ though and I can understand doctors frustration with this, but to suggest that frivolous lawsuits dominate is a gross exaggeration. I personally can see no better way to do things…
Just my thoughts…
2 Anonymous December 21, 2005 at 5:32 pm: Here’s a better way. Have one expert for both sides with questions submitted in advance and a screening process to get the right expert which can be agreed upon by both sides. Neither side gets to ‘PREP’ the expert and guess what lying would be kept to a minimun and many cases would never be filed. Heres another idea loser pays. How about one more? No contingency fees. You know the US is the only country with contingency fees?
3 Anonymous October 4, 2009 at 12:17 pm: Here’s my take on the whole defensive medicine argument. You’re willing to risk your patient’s eyesight in the event that your phone diagnosis is wrong. You’re just not willing to risk your own financial health.