See both sides here - I've refused scopes that were indicated by CYA standards, but which lab results and personal history indicated tincture of time and a change of meds was probably going to be sufficient to correct. (They were).

However, my father-in-law perished when his colon cancer went undiagnosed until it was well past too late to treat with anything but palliative measures. He got regular physicals at the behest of my MIL. His internist failed over a period of ten years to order a routine colonoscopy screening despite FIL's age, additional risk factors (family history, lifestyle, and previous history of colon polyps (known to the internist), and instead of testing suggested diet change when symptoms began that should have immediately triggered a scope, and later still misdiagnosed a palpable rectal mass as an enlarged prostate.

Medical review by plural GI specialists was unanimous the internist failed to meet the standard of care - by a mile.

This guy looking at the xray has to be a lawyer. The chest film is upside down. He can still be a doctor, though.

Lot of jumps in logic to reach your conclusions, Kevin. I wonder if you linked the wrong article, because this one doesn't remotely support some of your personal interpretations.

By the way, what "lawyers for doctors" are claiming that diagnoses are being missed at an alarming rate?

Doctor, Lawyer or whoever, he is posing for a picture, so what?

Does that mean when my Drs. have turned my X-Rays all different positions, to look closely at something, he must be a Lawyer in drag?

"It is revolting how you guys view and treat your patients."

Not as revolting as how some patients view their physicians as sources of free care, aka free phone calls, not wanting to pay co-pays, and the like. Not as revolting as patients who don't follow their advised medical care, but yet sue us because the bad outcome is our fault.

"how in the world are you going to handle the stress(that you create for yourselves)"

We're not lawyers.

"You prove over and over what type Dr. you are."

You can tell how good a doc aperson by how the person writes in a medical Blog? You must be a great evaluator of people. Maybe an insurance adjuster? Are you aware that every anonymous on this site could be a different person, but you can evaluate all of them as one person by how they write?

keep practicing defensive medicine..then the patients above can't hurt us monetarily, but we can keep hurting them with unnecessary tests, prolongation of terminal illness, etc... I would take a berating in a courtroom to that anyday...

I am not a huge fan of screening, I realize that it has benefits and risks and that early diagnosis often doesn't make a difference. I also understand that delay in diagnosis by itself doesn't necessarily mean malpractice. I also realize that just because something is visible or clear in hindsight doesn't mean it could've been noticed sooner.

But a couple of the examples given in the article stand out:
a) a man whose rectal bleeding was dismissed by a doctor as caused by bear drinking. Isn't a diagnostic colonoscopy a standard-of-care when there is bleeding? Or would you consider it defensive?

b) taking out healthy breast tissue instead of cancerous. I realize that they have to take more, but from the article it appears that the cancerous tissue was left in place but the healthy was taken instead. Is this OK? How would practicing defensively save you here?

One other thing I'd like to understand about defensive testing. Some patients ask for it specifically, I have no problem with your ordering tests for them. But some patients don't want it and are willing to sign any kind of form. Since the vast majority of patients don't sue (give me numbers if I am wrong, I do have an open mind here), they essentially suffer harm and pay (if they have high deductible) for your piece of mind. How is making patients pay for your benefit is different from stealing? How is it morally better than say a maid stealing jewelry from a rich family because she has a sick child? Her need is greater. And why is harming our health an acceptable price to pay for your protection? Again, I am not talking about patients who insist on tests. Only about those who'd like to know the odds and to have a right to refuse.

Most of us have never sued anyone..your attitute and general treatment of human beings turns people off and make them want to sue you. Maybe it is because we have lived and believed in the profession of medicine to be most respectable and we place you above most other people. Then you come along and call us names and treat us in a way that we never associated with your profession. Most of us laypeople have believed you went into your profession because you wanted to practice medicine, that you CARED about human life, that you choose to help those most in need.. You make it obvious that you are it only for yourself..

As for me personally,your way of parcticing medicine not only makes me angry, it makes me realize how very selfish you are. You don't care that what you are doing is driving more and more people to the uninsured catagory...Employees can no longer afford to carry ins. and employers are in many cases cancelling policies or providing terrible plans to their employees.

Maybe because of the difference of incomes, between your profession and many of ours, that you can't comprehend how this effects the average person..You are going to test yourselves right out of business. Or, you will drive the country into a forced national healthcare situation.

it seems as though you don't even want to do anything to force a change. When we ask, "What can we do to help stop what is happening to healthcare, tell us how to help you?" Your response is pretty much "screw you, I'm taking care of myself, I don't trust you, I don't believe you, so, your going to get tested to death."

Your going to cause the end of healthcare as we know it..

We all need to understand be it law or medicine nobody goes there to simply help people,considering the huge personal investment a person has to make.but still a person can do the best for his client or patient and can expect to earn a good living.They are not necessarily contradictory.Health has never been a free lunch and never will be,and it has to be earned and and maintained like any other asset. period.human beings are necessarily narcissists and will always love and preserve oneself, Comparable to the situation is in my crowded OPD( not an ER) in Delhi where no patient gives a shit about since how long I am starving I can't blame them because that is their way of self preservation.Medicines purpose as an altruistic profession is thoroughly mistaken .Few people are and always will be irrespective of whatever field they may go but forced altruism is a perfect recipe for disaster, it breeds corruption.Considering this the doctor who saves his ass by overtesting is just being cautious, because we all human beings do it for survival.

"taking out healthy breast tissue instead of cancerous. I realize that they have to take more, but from the article it appears that the cancerous tissue was left in place but the healthy was taken instead. Is this OK? How would practicing defensively save you here?"

The defensive move here would be to do a radical bilateral total mastectomy with axillary node removel. You wouldn't miss anything.

To the writer above who says we doctors are destroying medicine by practicing defensively: It must be a collective conspiracy, because We all do it, it's hard not to. What other choice do I have? Here's a great example: On Friday a woman with a history of IV drug abuse came to the ER with back pain. It was paraspinal, meaning not over the spine. IV drug abusers are at risk for spine infections (remember, pain was not over the spine) but the ER doc, to protect himself, got a CYA spinal MRI. It was read as "negative" by the radiology resident. The patient was sent home. The next day the radiologist (Attending) read the clinical history, he called the ER and said "I cannot rule out Osteomyelitis based on this MRI." I was working, I called the patient at home and told her to come back. I examined her, she didn't even have pain over her spine! But I had to admit her for heavy-duty IV antibiotics now that the groundwork was layed. The doc I admitted her to demanded more testing, ie Blood cultures, Sed rate, etc. Entire cost of visits, etc about $25,000. For a low back strain. Your Tax dollars hard at work.

"you can always refuse but then we document that the patient refused the test to cover ourselves...either way we won..."

Several lawyers on this and other sites have stated that simply documenting that "the patient refused the test" would be thrown out in court. A Plaintiffs' attorney would argue thatthe physician made it up to cover himself. One lawyer even said he uses such statements as "evidence of your Shoddy care" by forcing a patient to refuse. You need to get a signed AMA, where it's documented that the patient understands the risks of their decision, including death. One lawyer even told me he is good enough to get AMA's thrown out in court, but it's the best we can do.

Car accidents are not "random" - they are usually caused by someone being careless or even reckless.

"I drive my car every day, and risk being sued every day just like you."

Perfect example.

When you drive, do you wear your seat belt?

I assume if you are drinking, you let someone else drive, to be safe?

I assume you're not Britney Spears, so you put your infant in the Child Safety Seat?

If your brakes malfunction, I assume you don't keep driving, you bring it to a repair shop?

Do you drive 120 miles an hour on the highway?

I have a responsibility to my spouse and children not to take extra risk at work.

I never take extra risk when I drive, I certainly am not going to take extra risk at work if I can avoid it.
Justifying the tort system by saying "just take it" is no justification at all.

"Much of the time, when that something bad happens, the patient looks to sue the doc because of the potential of a big payday,"

According to. . . . you?

every doctor will get sued if they practice long enough...how many people do you know who have been sued over a car accident?

I guess the 90-year-old physician was such an anomaly that kevin had to post about it...

This line of reasoning (I can get sued for driving a car, so it legitimazes medical malpractice lawsuits) makes no logical sense. It's OK to sue Mcdonalds because you are fat, it's Mcdonalds fault, so it's OK to sue a doctor, because you had a bad outcome, it has to be the doctors fault. Just because in this sue-crazy country you can get sued for everything doesn't legitimize medical lawsuits.

"This line of reasoning (I can get sued for driving a car, so it legitimazes medical malpractice lawsuits) makes no logical sense."

Your premise is wrong. No one has said that but you. You can't get sued merely for driving a car, it's only when your driving of that car is negligent and results in harm to others that you can get sued. Same with med mal.

"It's OK to sue Mcdonalds because you are fat, it's Mcdonalds fault, so it's OK to sue a doctor, because you had a bad outcome, it has to be the doctors fault."

More wrong premises - you're have a bad day. Or maybe they are just your own personal misconceptions - still they are wrong.

"Just because in this sue-crazy country you can get sued for everything doesn't legitimize medical lawsuits."

Actually, tort filings are down over the last decade, as are average payouts. 0 for 3 for you today, and all in one post.

CJD

I wonder what the writers of the Bill of Rights would think of today's Lottery Based out-of -control suffocation of physicians, that 2-3% of GDP is spent on lawsuits, that hundreds of billions of dollars are wasted on Defensive Medicine. Oh yeah, they were too busy buying slaves to worry about the future.

I guess all these patient posts answer the guy's question about why we need to practice defensive medicine...

You really think the majority of lawsuits are "cutting off the wrong leg", or removing the wrong kidney?

Uh, no. But the opinion of my old boss Illustrate a certain attitude that doctor's should be specially protected somehow from lawsuit because of the altruism of doctors and the inherent risk of medical treatments, the egregious example of malpractice included.

What is your test for the legitimacy of a suit brought against an MD?

You guys keep saying doctors are human, you can't be responsible for making mistakes, it's all the patient's fault, blah blah blah.

Boo freakin' hoo. When is the last time anyone here actually apologized to a patient when something went wrong? Were you honest? Or did you make excuses for yourself and try to sweep the whole thing under the rug? Do you honestly think patients don't deserve some compensation if the wrong leg is amputated?

Get off your defensive high horses, people. Every single one of you has made errors that either harmed a patient or had the potential to harm a patient. If you want to circle the wagons and try to blame patients, lawyers and whomever else, fine. But then you shouldn't be surprised when patients turn to the court system to obtain the justice you have arrogantly denied them.

we never said we were perfect that...what we did say was we are going to continue to screw people like you and order unecessary tests and referrals (everone of you will be a victim of this at some point if you haven't already) and gang-bang you with cya consults and tests and ct scans and iv dye when you are in the hospital and then put you on a ventilator to keep you a vegetable for as long as possible...

Would someone please suggest a solution, a reasonable, realistic solution? No, it's not reasonable that doctors should be excused from responsibility ("First, do no harm" -- sound familiar?). And it's not reasonable to assume that all lawsuits are frivolous (the definition of 'frivolous' is not 'I'm the defendant therefore..."). So now what?

anon 3:16. Whatever your drinking, you should stop and go take a nap.

Is there any Dr. out there, any where, that believes this guy is REAL? If he is then you should offer to help him. He is losing it.

This is the problem: I have Carte Blanche to order any test I want, "just in the case" the patient has the disease. One giant national game of "find the needle in the haystack". I used to write the word "DEFENSE" on the board of the community ER I worked in, to remind myself, it's us against them, I better over-test. There is no penalty for overtesting, there cannot be. WHoever creates such a penalty becomes responsible for the medical errors that occur if we limit tests. So the system shells out the money, to do all these tests, we are responsible to order these tests to defend ourselves, and we agree to take the beating when a bad outcome occurs. Why didn't you order that CT Scan, Dr. Schwartz? "It's like an unwritten contract. The only one who pays is the patients.

You can't get sued merely for driving a car, it's only when your driving of that car is negligent and results in harm to others that you can get sued. Same with med mal.
OK, since I am the one who mentioned cars in the first place let me tell you what happened. My
father was making a left turn on a green arrow when some guy hit him from behind (the guy was driving in the same direction that my father was turning to). The guy run the red light, but there were no witnesses. The police came, the other guy claimed he was driving on green and it was my father who run the red light. My father could barely speak English by the way, it was less than 2 years after we had immigrated to the US as refugees from a communist country. My father was driving a new Datsun 210 (this was at the time of Iran contra affair when everybody was trying to save on gas) - our first new car, a guy who hit him some old car that looked like it was worth $200.

Some months later, we got a letter saying that we are being sued for $1500. Now this seems like a very small amount, but it was a lot for us then. We couldn't take anything with us when we came to the US, my father who had been a mechanical engineer only managed to get a job in some plant as a layoutman for about $7 an hour and my mother - an electical engineer - still couldn't find a job. I was in college on a scholarship and working part time for a minimum wage. $1000 was huge, especially after we spent all of our savings on the downpayment for this car. Also, we were just starting to build our credit history (one reason we took this car loan) and we worried that this type of things will ruin it for years to come.
The insurance company had a lawyer (now I am surprised they didn't want to settle, but I guess they thought the whole thing was frivolous based on the pictures of the accident). My father went to court a couple of times, the other guy didn't show up, the judge ordered this guy's lawyer to pay my father $50 each time as a compensation. At this point it seemed like it was over.

Some 3 years later we got another lawsuit. This time we were sued (for the same accident) for $5000. The guy claimed car damages and also some medical expenses. Even though he was perfectly fine after the accident (and he hit my father's car from behind), he claimed he went to the ER, had to do some tests, whatever.... His name also "magically" changed - from James O. to Philip. I guess his brother wanted some money. My father went to court, but as his English was still not great - he doesn't have any aptitude for languages and he was in his late 40s at the time - he couldn't tell me and my mother what happened: he told "my lawyer was talking, I told the story, the other guy was talking and then the lawyer was talking. I guess the other guy lost, but I am not really sure". Now it sounds pretty funny, but it was stressful and this amounts were pretty big for us then.

There are lots of situation in this country when people get sued. Somebody in my community sued her friend for a million dollars after slipping on her friend's stairs. The woman lost eventually but now after pretty much ruining 6 years of her friend's life. Nobody could understand how this woman who sued could do it- virtually all mutual acquintances stopped talking with her - but she thought herself very "americanized", I guess.

I do understand that doctors have higher risk of being sued. But I do believe that the majority of us don't sue. I cannot see suing any of my doctors except for something outrageous like cutting the wrong leg. The posters above mentioned that the lifetime risk of a doctor to be sued at least once is 90%, but during this time the doctor will see a lot of patients, and probably will miss more than one diagnosis. I still think it is morally wrong to order unnecessary tests and then to make a patient pay for it. But I understand why you do it.

After that sob story why is it you are defending these godda** lawyers! Unbelievable...

After that sob story why is it you are defending these godda** lawyers! Unbelievable...
I've never defended lawyers. I hate the litigiousness of the US society. I do believe that a couple of examples in the article could've been legit (taking out wrong tissue and not investigating rectal bleeding - note I say could've been since I don't know the details), and I also don't like the fact that as a patient I may be subjected to unnecessary testing. I do think large part of the blame lies with "expert witnesses" and with unrealilstic expectations created by advertising.

Sorry for posting a story off-topic btw. I couldn't let a lawyer's comment that all car accident lawsuits are because of negligence. This was in Chicago, by the way. Besides, in hindsight the story seems funny enough.

Having read this whole thread, I've got to tell you that the older I get the less I'm impressed with the behavior of doctors, lawyers, or any other professionals. And I am one. Few are practicing the "Golden Rule" of "Do unto others as you would have them do unto you."

in my post above, change Anon 5:00pm to bad shift.

"Do you know of a country that has a better system?"

Most 3rd world countries...they insitutionally put patients in their place...in this country the doctors have to put them in their place by ordering unnecessary poking and prodding...

1. patients will be sent to the e.r. to get tests there...emergency care is almost always paid for.
2. the insurance companies will pay for the tests, and they do now, for the reason that if they don't they may get sued (what a surprise) for the medical negligence that goes along with not doing the test (which is necessary in 0.001% of cases).
3. guess what, you may have to pay out of pocket if none of the above apply...and take responsibility for health care just like you pay bills for your 500 channel cable tv plan, etc...

Reading the above comments from sue-happy, self-absorbed, whiny patients and their greedy lawyers makes me so glad that I quit medicine in my 40's. At first I felt guilty that I was quitting when there was such a big shortage of radiologists but not any more. Thank you for reminding why I made the best decision of my life.

Where is a sue happy patient in this thread? Where is one that has ever filed even one lawsuit against a doc.? Are you speaking of some of the responses that were made to the most mean mouthed arrogant Doctor in history? If so, then I'm as happy as you that you got out of medicine. I'm certain the patients you no longer have are equally happy!