It is true that given the unlimited potential of medical technology that the "sky is the limit" with regard to how many studies a physician can order for a patient. Or to what extent physicians can treat a patient. I had a 72 y/o patient who was referred to me for a screening colonoscopy. She had severe COPD, coronary artery disease resulting in multiple episodes of congestive heart failure, was morbidly obese, was nonambulatory due to amputations from complications of her diabetes, and lived in a nursing home. After I thoroughly explained the risks and benefits of the procedure to the patient's husband, he stated that he wanted to proceed with the test. The likelihood of the patient succumbing to colon cancer over her other overwhelming medical illnesses was close to nil. But the patient's husband did not have to worry about the cost, we taxpayers would be covering it. Should I have refused to offer the procedure? But some other physician would probably be doing it. Where do we draw the line? (And by the way, I know there will be some who wonder...the patient is not DNR.)

do the colonoscopy...the reason the patient was referred in the first place is because the primary care physician didn't want to assume the liability of not doing it...do you?

anon 7:16...this is one of the few benefits left of being a doctor...you can take care of your family and friends...this is something that the lawyers and patients can't take away from us...

don't you want to make a living? If you a refer a patient to a surgeon, the patient will get cut...if you refer the patient to a gi, the patient shoud get scoped!

What is the likelihood that if you don't do X at work, that you will be sued?

Going further, what is the likelihood that if you do get sued, X result will happen?

What is the worst case scenario of the lawsuit, and what is the best and most effective way to alleviate that risk and still practice how you want to?

You don't know the answers, so you let your fear of the unknown rule you rather than actually investigate the unknown.

So we should make policy based on your inability to deal with stress?

You should not be a physician if you can't handle risk.

The gentleman in question hasn't even assessed the risk, so how can you call it a "frivolous malpractice environment". Fact is, you know literally nothing about the merits of 99% of cases, nothing about the win/loss ratio, nothing about the payouts per type of case, etc.

I don't even think you should deal with it at this point, because that would assume you understood it. You don't have the first clue about the disease, so why even talk about a cure?

I would think that the ability and willingness to gather the facts, analyze the data, and then make rational decisions based on both would be a large part of being a good doctor. Evidently the poster in question is unable to do that given his high degree of stress over something he barely, if at all, understands. Or are those not very necessary skills for a good physician?

He is probably a nice guy, but he is frightened and angry over something he knows nothing about, other than that he doesn't like it. For his own sake, he should get out before he breaks down.

CJD, since you turned to personal attacks, which you usually do when you run out of ideas (I don't know how the judge deals with you in court when you act that way), it's pretty pathetic that you are on the losing end of so many of these arguments when arguing is what you do for a living and we're just a bunch of (your words) uninformed doctors. You must be on this site so much because you're such an incompetent lawyer.

"Abdominal CT with contrast might be the best way to go here."

If you're looking for a grapefruit sized tumor it is. But it's only a $1500 test in the US ($200 in Canada) so let's order it "just in case"

"CJD, since you turned to personal attacks"

That wasn't an attack in the least. I was correct about everything I said. And I truly believe he should get out of medicine if that is the stress he feels. It can't be health for him.

I didn't win or lose an argument. It wasn't an argument. It was simply a very correct observation that the physician is overwhelmed by risks he has not even taken the time to properly assess.

You must be in the same boat, which is why you feel it was personal.

"What is the probability that this particular patient will get colon cancer and sue you?"

Unfortunately, there is alot more legal $$$$$ in errors of ommission then there is in errors of commision, especially since patients sign consents which explain risks of procedure including perforation. That's why we do so many useless tests in this country. In the current climate I never worry about the cancer the CT scanner is causing when I do all these CYA CT scans.

My 78 year old mother was FORCED to submit to a colon scan before leaving a brief stay at the hosp. They perforated her colon. A woman that should be at home watching her stories is now given no hope to live. The doctors did NOT make clear to her the risks of doing this procedure on an old person.
Now after 8 weeks they have milked the cash cow for all it is worth and want to begin comfort therapy (pillow over the face?????) or kick her out of the hospital. Seeing my dying mother on a respirator with her tounge hanging out is not nearly as disgusting as watching the parade of giant MD egos and the all female administrative staff with CYA tatooed on their eyelids.