Duh! Will Dr. Brenda Sirovich, assistant professor of medicine at Dartmouth Medical School, Bend over and take it when we don't order a defensive test, the patient has a bad outcome, and the Lawyer Sodomites come knocking? Doesn't every patient with a UTI need a full cystoscopy?

As more doctors practice medicine a certain way, that practice becomes the standard of care, such that if one doesn't do it that way and there's a bad outcome, one is told he deviated from the standard of care.
Any patient with a headache seen by a neurologist gets an MRI of the brain.
Twenty five years ago, a 25 year old male who presented to the ER for chest pain might just have a chest xray. Now, he is hooked to a monitor, and a 12 lead EKG and a battery of blood tests with heart enzymes are being done.
An 18 year old female who woke up this morning with leg pain will have an ultrasound of that leg regardless of whether there are risk factors or not for blood clots.
A healthy 50 year old who passed out for a few seconds will have a cardiac work up, CT of the brain, ultrasound of the carotid arteries and will be admitted for observation and have an EEG and an MRI of his brain.
Twenty years ago I can refer my patients to a general orthopedics surgeon for a broken thumb, now I have to send them to a hand specialist because it appears that this has become the standard of care.
And there are more examples, that most practicing physicians know about.
And as doctors do it a certain way, slowly and eventually, the practice becomes the so called "standard of care".

http://www.surgicenteronline.com/hotnews/5ah2412395699394.html

This is a better summary of the research and the rationale for why it is important. The variations do not change outcomes.

In short, overtreatment raises costs, does not improve outcomes, and fails to immunize or even reduce malpraactice risk. Explain to me again how this is all the lawyers' fault.

Grow up.

Here is the link to the abstract from the Archives of Medicine of Dr. Sirovich's study:

http://archinte.ama-assn.org/cgi/content/abstract/165/19/2252

Only an idiot like Dr. Elliot or his buddy CJD would claim that there is not a real threat of a lawsuit from any patient you see. Why do you guys argue with these cretins about stuff that you already know to be true? What a waste of time.

Are you going to Law school?


No life is too short to waste on that. Although I know several physicians aren't the brightest that were able to sleep their way through law school night classes in a few years and pass the bar.

My brothers and I have started a business that we are growing

How do you convince the public? How do you convince an asshole plaintiff lawyer?
I don't think you can convince a lawyer -- they want money evidence against notwithstanding.
If you want to convince the public that extra tests/treatment doesn't prolong life, you should start by convincing the media. The prevailing message on TV/radio/newspapers now is 'you cannot go wrong by having more tests'. The preventive drug advertisedments are everywhere. I especially like the one with healthy slim woman in a swimming suit talking about bad cholesterol.

Convincing the media means raining in the 'doctors on TV', changing content of various "informational" websites, changing the tone of the interviews some of your collegues give to the press,etc. Instead of a made-for-TV movie of how so-and-so-poor-soul had advanced desease X because a terrible doctor/lab technician hadn't order a test/interpreted the test incorrectly, publicize a case of someone whose life turned to hell because of invasive tests that caused complications.
The company I work for have been giving small rebates for non-smoking and exercise. This was great for me because Idon't smoke and exercise. Besides, there is overwhelming evidence that smoking is bad and exercise is good. Now they introduced a new 'healthy living' rebate which among other thing means having annual physicals and all recommended (or not-exactly-recommended - e.g. PSA) tests. Never mind that there is no evidence that annual physicals do any good and that screening is a complex decision even for tests that are proven to work. An interesting thing is that from company's "saving money" perspective, these tests are not even cost-effective: they often result in additional tests, more people being treated for some desease that would've never been found. Could someone explain to me, where the company's desision-makers decided that offering this rebate is a good business.

I think that the prevailing mindset is best expressed by some of my collegues I had lunch with the other day: "we do oil changes in cars to save money for repair and to make car survive longer, it is the same thing for us". I tried to explain that this is not quite the same, but most people didn't get it. And I work in a research lab with scientists and engineers. If they cannot get the difference, how can you expect the general public get it?

OOps, thank god my breast didn't get infected when my cat scratched it.
I also get hives in various places of my body around end-of-August/September/October timeframe - don't know if it is allergy or some kind of invisible bugs (or if my indoor-only cat gets invisible flees only during these months...). My one nightmare this year was that I would get one on my breast (as I occasionally do) right before my ObGyn visit and would have to undergo a cycle of tests.

The above work up is still not up to our standard here at the high price region of Pennsylvania.
I recommend including CMP to excude primary biliary cirrhosis, RMSF titer, Lyme disease titer,RPR(to rule out syphilis) HIV, Hepatitis panel, West Nile Virus IgG and IgM titer, TB skin test.
A referral to a Psychiatrist will be taken into consideration for possible Neurodermatitis.

Thanks for list of possibilities and a free medical advice, I feel better already. Oops, but it is November, so I am fine anyway.
I thought it could be an allergy given its seasonal nature.

If I do the rest of the tests I'll have a heart attack or stroke and then I don't need to worry about hives (or will be fired from my job for not having time to do any work - then I'll have no money for either doctors or tests).

If it is you might someday see an attorney about delayed diagnosis.
if only I had complained... otherwise I have nobody to sue.

YOu guys are leaving yourself as open as a hooker on a Saturday Night! Even with all those tests, you could miss the diagnosis. You need to admit so she becomes someone elses legal responsibility, or coerce an AMA!

Great. Now she is in my ER. I can't remember all those tests to order but hey, it could progress to an airway problem. I'll intubate her. Intensivist please.