Chris Rangel talks about his case of defensive medicine
“Last week I admitted a woman in her 40s, relatively healthy, who had suffered a syncopal event (passed out). The woman had taken a gazillion doses of Benadryl (self medicating for a prior allergic reaction to food), didn’t sleep well, and had not eaten that day. Initial routine work-up was negative and every aspect of my training and experience told me that this patient had no serious underlying illness that had caused her syncope.
By her history she had a simple faint. She really didn’t even totally pass out! But I couldn’t be 100% sure. If this woman goes home and dies from some condition (no matter how rare) that I didn’t test for then I’ll be in lawsuit hell. So I ordered a ton of expensive tests and cardiology and neurology consults who ordered even more exotic and expensive tests. Result? –> Zip. Zero. Nada. Nunca. Nothi’n . . and this case is far from unusual. So basically I blew up her hospital bill by thousands of dollars. But she doesn’t pay for any of this excess cost and neither do I (neither do I benefit from it).”
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{ 3 comments }
As a private practice internist, I am very sensitive to malpractice and “customer service” pressure, but wouldn’t a history and an echo be sufficient in this straightforward case?
Actually a good history and physicial exam should be enough in this case.
The question becomes, “I you feel lucky? Well, do ya . . punk?”
A healthy young woman with everything to live for and an event that could signal a potentually fatal disease . . the other question is would you feel comfortable on the stand defending your management of this case.
That’s what I often think of in these cases. The sad truth is that most physicians believe that they can defend any case as long as there is extensive testing.
Funny, that’s true (I feel more comfortable discharging someone if they’ve had tons of defensive tests) Here’s the other sick thing I do: I find i’m more likely to discharge a patient from the ER if I look at “demographics” on the chart and see they don’t have a “next of kin”. I really hate what litigation has done to my career.
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