Kate Steadman thinks defensive medicine doesn’t exist:

The bottom line is that while the evidence isn’t crystal clear that defensive medicine plays no part, there’s nothing that shows defensive medicine is dictating doctors’ behavior. More contemporary research needs to be done (the majority of these projects were in the late 1980′s and early 1990′s), but there’s no indication of a rash of doctors performing unnecessary procedures and tests because of their fear of frivolous lawsuits.

Please educate her. (via Overlawyered)

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  • Anonymous

    Out of those 100,000 people who die each year of medical error, how many families file a lawsuit? Does anyone know? I bet the answer would surprise some of the doctors who believe everyone files them.

    Also, how does someone get a death listed as being “Caused by medical error”? Aren’t most of them covered up? I’ve never heard of any Dr. saying that he would be happy to list the cause of death as being his fault.

  • Anonymous

    These reports of 100,000 people dying each year from medical errors is such fallacy.

    An 80 year old diabetic with a 80 pack year history of smoking languishes in in the ICU after a heart attack and pneumonia with renal failure. She dies. A reviewer scours the chart and finds that she was given a medication an hour late or given the wrong dose. Most of these are medically insignificant but nevertheless classified as an “error”. Did it directly lead to the death of the patient? No, death can’t be stopped.

  • Amy Tuteur, MD

    The C-section rate is rapidly approaching 30%. That’s at least twice what it ought to be, and last I heard babies have not doubled in size and fetal distress has not doubled in incidence. If that’s not defensive medicine, I don’t know what is.

  • Anonymous

    The first commenter is right. All we do in hospitals is commit medical errors. We actually plan them. I pray to god every night when I go to sleep the lawyers sue us even more to completely cause the system to collapse (not that we’re that far from it, with the patient volume increasing every day) and then once the system completely collapses, it can be fixed, sans the lawyers.

  • Anonymous

    Amy: I wouldn’t use my real name if I were you. Lawyers have been known to cut comments from weblogs and use them in court.If you’re an OB, I could see one of these guys using the above comment if you deliver a baby with Birth defects by NVD as evidence you should have gone the C-section way. They’d just have to google you. Just be anonymous like the rest of us. Unless you’re lucky enough to be practicing in the Great White North.

  • Anonymous

    Did you check amy tuteur’s weblogs linked under her name? All she does is rail against doctors…don’t feel to protective of her.

  • Anonymous

    Anonymous 9:57 is a very, very smart guy. Everyone should listen to him.

    Even if defensive medicine does exist, so what? Short of absolute immunity, there is nothing that is going to change its existence.

    At best, it’s all anecdotal evidence that it exists, at worst (for the patients) some things get caught that wouldn’t otherwise. The docs still get paid for it, or at least don’t get paid at a rate any higher than what they otherwise would.

    Doctors believe it exists, and they don’t need any actual proof thereof. Again, so what? What does it prove and what does it change? Nothing. They’ll do it with or without tort reform, and they will never get immunity.

    CJD

  • Anonymous

    CJD: Canada: No lawyers. (Well, lawyers, but they wear funny robes and more importantly, they practice law, not appear on TV asking “Did you slip and fall in the Walmart?) No Defensive medicine. This post has nothing to do with “socialized”medicine, just the fact that in other countries, you cut out the Lawyers, you cut out the defense.

  • Anonymous

    cjd is a smart guy…everyone should listen to him. He is absolutely right, no matter what you people do, tort reform, or not, you’re going to get scanned, x-rayed, biopsied, catheterized, endoscoped, cystoscoped and then finally placed on a ventilator with the levophed and neosynephrine wide open…enjoy!

  • Anonymous

    Canada: No need for damages to pay past and future medical bills. You cut out the need to pay for medical bills, you cut out the vast majority of med mal claims.

    Wanna make the trade? Remember, you get paid what they do, too. And the government doesn’t just control you partly, it owns you fully.

    Of course, they might start measuring your performance a little more closely, too.

    CJD

  • Anonymous

    I knew you would answer with an argument against socialized medicine. I was answering your argument: You said if we got rid of the lawyers, we would still practice defensive medicine. I answered with the example of a country which has neither. You changed the subject. As I predicted you would.

    To repeat:
    “This post has nothing to do with “socialized”medicine, just the fact that in other countries, you cut out the Lawyers, you cut out the defense.”

  • Anonymous

    OMG, you’re right! Tuteur’s entire Blog rails against ER’s. She wouldn’t even have gotten in from the waiting room at my hospital in the 7 hours it took for her sons’ care to be screwed up in her story, all the ER’s fault, not the Ortho departments. But then again, she “knew” it wasn’t busy.

  • Anonymous

    It’s not an argument AGAINST socialized medicine. It’s simply pointing out how silly your post is when you cite Canada. You might have well have said that because there were fewer convertibles sold in Canada, that means less defensive medicine.

    CJD

  • Amy Tuteur, MD

    This is off topic, but…

    if anyone thinks a 7 hour wait in an emergency room is acceptable for a patient who is essentially a direct admit, you’ve demonstrated the entire rationale for my blog.

    It is medically and administratively unnecessary and happens because doctors have no clue how long patients wait, and don’t think they need to care about it.

    As to how I “knew” that the ER wasn’t busy, I did not have to draw on my years of experience working in ERs; all I had to do was to look and see that there were very few patients present.

  • Anonymous

    To anonymous 10:13, don’t worry, Amy Tuteurs’ husband according to her blog works in a law office…so, he’s probably a lawyer.

  • Anonymous

    “if anyone thinks a 7 hour wait in an emergency room is acceptable for a patient who is essentially a direct admit, you’ve demonstrated the entire rationale for my blog.”

    You sound like a lunatic. Do you even practice medicine? Patients wait because other patients come in without appointments and screw up the remainder of the schedule for the day.

    I know non-physician patients who had physician friends who arranged for them to be admitted and promptly worked up within minutes to hours…you must have no pull at that hospital…if you were a real doctor you would have some connections at a hospital or friends who would have taken care of your son…maybe instead of writing a blog all day you should practice real medicine then you would get to know other physicians who could help you in your time of need so you wouldn’t have to wait liek the masses…or maybe the other doctors know about your blog so they intentionally make your family wait…I would if I knew who you were…

  • Anonymous

    For those interested the 100,000 thousand deaths per year statistic goes back to the “To err is Human” article from the Institute of Medicine. What they negate to mention (unless you dig through the data) is they use numbers going back to early 80′s research. They don’t actually do the orginal research themselves. In reality they don’t have a clue.

  • Anonymous

    “if anyone thinks a 7 hour wait in an emergency room is acceptable for a patient who is essentially a direct admit”

    Amy either a patient is a direct admit or not. Going through the ER is NOT “essentially a direct admit”. If it isn’t a direct admit the ER does your footwork for you while you are in bed. If the wait ticks you off so much I suggest you admit a REAL direct admit yourself.

  • Amy Tuteur, MD

    You are avoiding my point. In my professional and personal opinion, 7 hours is too long to wait in that situation. Instead of reflexively insisting that the ER is always perfectly run, you need to explain under what conditions a 7 hour wait is acceptable. If those conditions aren’t met, then the wait isn’t acceptable. It just falls under the heading of: “if you choose to come to the ER, you’ll wait until we’re damn well ready to see you.”

  • Anonymous

    no one said emergency rooms are perfectly run. Idiot patients and patients without primary care physicians come to the er for non-emergent problems and clog it up. Even you, supposedly a physician, could have directly admitted your own family member but instead chose to go through the er and further clog it up. The people who get priority are people who are crashing and trauma patients/cva/mi’s, etc. A child with an infected arm that is not septic can wait…what world are you living in?

  • Anonymous

    Amy is being a mom not a doctor…understandable. But I do believe it is clouding her opinion on the matter. Though the waiting room wasn’t busy we all know it only takes one or two sick sick people to eat up alot of time and people.

  • Anonymous

    Blah, Blah, Blah anon ER Doc your song and dance is getting old. Why not give it a break. You attack every person, physician or otherwise, if they dare to disagree with you. I hope that one day you need medical care and you receive as good as you give, disposition and all. I also hope your ass has to wait in an ER some where for hours on end.

  • Anonymous

    Anon 1:23, you should tell all those idiots waiting in the ER what you think of them so they can go to some other ER and save you the bother. Of course, you probably shouldn’t tell them that you are playing around on the PC while they are waiting for care and probably bleeding all over the waiting room.

  • Anonymous

    “You sound like a lunatic. Do you even practice medicine? Patients wait because other patients come in without appointments and screw up the remainder of the schedule for the day.”

    In your whole life, have you ever taken responsibility for anything? No wonder you’re so deathly afraid of being sued – you might find out you are actually responsible for something.

  • diora

    at worst (for the patients) some things get caught that wouldn’t otherwise.
    CJD, are you so completely clueless? Do you truly believe extra tests are harmless? I am a patient and I don’t want more tests than absolutely necessary. Why do you think you hava a right to decide for me?

    At worst, I’ll suffer side effects of the test – get an infection from an unnecessary biopsy for example or worse. At worst, I’ll get treated for a non-progressive desease and suffer or even die of side effects of the treatment. At worst, a child will get cancer 10 years after a few unnecessary cat scans. Granted this is rare, but if the benefits are also rare than …

    Lawyers have been known to cut comments from weblogs and use them in court
    Here is a thought. Maybe patients not wishing defensive treatment should post under their names. This way, doctors will always be able to use their posts as the proof that they knew the consequences of their refusal to undergo some tests.

  • Anonymous

    “Why do you think you hava a right to decide for me?”

    I don’t have that right at all, and it’s not me making the decision. It’s your physician that is deciding that. There is nothing preventing you from asking for information on the tests and declining them. Well, nothing but the fact that physicians are paid in such a messed up way that spending more time with you is not profitable. Which is a gripe you should take up with your health insurer.

    Since the nature of defensive medicine is that it is merely what a physician says it is, and that changes depending on the audience, your claims as to whether defensive medicine caused this or that result are impossible to support one way or another.

    CJD

  • Anonymous

    “if anyone thinks a 7 hour wait in an emergency room is acceptable for a patient who is essentially a direct admit”

    And that’s the ER’s Fault? I constantly see patients who I document as “sent from clinic for direct admission”. Meanwhile the system is falling apart. But according to Amy Tuteur, who claims to have worked in ER’s (yes I rotated through the ER as a med student too) it’s the ER’s fault when you call the ortho on call and they tell you “go to the ER, get yourself admitted, we’ll see you when we get a chance”. Can’t interrupt that daily routine, even if it clogs up the system. But Amy Tuteur MD, says it’s all the ER’s fault. We’re all busy eating donuts and pie with all the cops who hang out in the ER. I can’t tell you the last time I ate a meal while at work.

  • Anonymous

    I have worked at the hospital that Dr. Tuteur brought her son. The problem at that hospital, and it’s ER, is that everybody who comes there “knows somebody”. There can be no VIP’s because everyone thinks they are a VIP. Makes it hard to get preferential treatment.

  • Amy Tuteur, MD

    Judging by the vehement response, I have clearly touched a nerve. It is precisely this defense of the indefensible that is responsible for a great deal of the misery in the current health care system.

    Time management experts agree that hospitals (including ERs) are run in a grossly ineffiecient manner. Quoting from The Boston Globe:

    “Boston Medical Center, the city’s safety net hospital, is becoming a model of how to bring relief to the nation’s beleaguered emergency rooms, reducing treatment delays and closures to ambulances when ERs are more crowded than ever. BMC emergency doctors are treating more patients than they did last year and have reduced average time in the waiting room from 60 minutes to 40 minutes.

    The secret lies in a radical idea for medicine, but one that has guided airport managers and restaurant hostesses for years: Keep the customers moving.

    Urged on by a Boston University consultant, the hospital is eliminating obstacles that force patients to needlessly remain in the ER. It is cleaning up empty hospital rooms faster and rescheduling elective surgeries so surgery patients don’t take up beds that emergency patients need.

    Meanwhile, ER nurses stationed in the waiting area assess a patient’s condition within minutes of arrival and then use a color-coded chart to track how long patients have been waiting.”

    So it’s pretty obvious that there is lots of room for improvement in the delivery of care in the ER.

    The topic of my blog has made some of you angry; you may not have noticed the subtitle: A Doctor’s Plea to the Healthcare Profession.

    So here’s my plea to you: Open your mind to the possibility that there is room for improvement in the miserable state of healthcare delivery. Consider how you, your office and your hospital might be part of that process. I’m not talking about doing more than what you do; I’m talking about pushing for efficiency and common courtesy. Most of all I am talking about opening your eyes to the misery all around you and realizing that you have both the abilty and the responsibility to improve the delivery of care.

  • Anonymous

    It doesn’t have to be this way in an ER..I live in a middle sized city. We use to wait for hours on end when you went to the ER. Exactly like what is portrayed here.

    About 2 years ago one of the hospitals started advertizing that you woudl be seen within 30 minutes of arriving at the hospital ER. Everyone thought “yeah sure”, probably seen by triage but surely not by a physician. Well, turned out we were all wrong..

    Rumors started floating that “You really do get seen (by a Dr.)in the ER now without waiting for hours.”

    This hospital began a “fast track” where patients who wern’t critically ill, or trauma were sent and they also opened a pediactric ER. Don’t put down the fast track patients, after all they are the reasons most ER stay in business. How many heart attacks and strokes do you see each day? Enough to keep all the ER open? I doubt it…..I’m not sure how they coordinate all this but it has improved satisfaction of their overall care. Obviously it hasn’t hurt the hospitals either. It is listed as one of the top 100 hospitals in the country and construction is booming. They are right now in the process of adding 2 additional 9 stories onto the main hosp. and have recently completed three large medical centers. So what is the problem with the rest of the hospitals in the country?

    One more thing..The nursing staff and physicians are caring and through. What is some of your problems?…If you don’t like your work environment then work to get it changed.Whining on some blog won’t do it.

  • Anonymous

    “what is the problem with the rest of the hospitals in the country?”

    Overcrowded ER’s with indigent and uninsured patients and welfare patients that doctors in private practice don’t want to see. About 40 million of them. Some hospitals because of their location don’t have to deal with that population and have the incentive to take care of paying, insured patients. I have worked in both and there’s a world of difference.

  • Anonymous

    anon 5;07

    I am not the angry unhinged ER doctor that always posts here, but there is lots of reasons why ER waits are long. I agree with the above poster. In an area of good demographics where a large portion of patients actually pay their bill then it behooves hospitals and physicians to become more efficient in order to compete. In areas where demographics are poor why would hospitals and doctors want to compete for the non-paying illegal alien patients? If you are a paying patient you suffer right along with them because of it

    Our group has really made a concerted effort for rapid medical evaluation. It is a little bit of a gimmick. You see a doctor right away and might get some tests started but if there is physically NO BEDS in the ER or the hospital then your overall visit isn’t necessarily shortened. In my state, California, there is a shortage of tens of thousands of nurses. If a few call off for the night you are just screwed. You might get seen by a doctor but no nurses to carry out the orders. It is not uncommon for every all 15 hospitals in a 15 mile radius to have absolutely NO beds wither because they are physically full or no nurse s people but if you CSS, you know what I mean. Layout in CSS2 is a pain if you try to avoid tables. I know there are some good examples of flexible multi-column layouts out there, but why was center not included as a valid float type? I would really like to know.as center not included as a valid float type? I would really like to know.

  • Anonymous

    anon 5;07

    I am not the angry unhinged ER doctor that always posts here, but there is lots of reasons why ER waits are long. I agree with the above poster. In an area of good demographics where a large portion of patients actually pay their bill then it behooves hospitals and physicians to become more efficient in order to compete. In areas where demographics are poor why would hospitals and doctors want to compete for the non-paying illegal alien, no-pay, and medicaid patients? If you are a paying patient you suffer right along with them because of it

    Our group has really made a concerted effort for rapid medical evaluation. It is a little bit of a gimmick. You see a doctor right away and might get some tests started but if there is physically NO BEDS in the ER or the hospital then your overall visit isn’t necessarily shortened. In my state, California, there is a shortage of tens of thousands of nurses. If a few call off for the night you are just screwed. You might get seen by a doctor but no nurses to carry out the orders. It is not uncommon for all 15 hospitals in a 20 mile radius to have absolutely NO beds either because they are physically full or no nurse staffing. If you are taking care of illegal aliens and medicaid patients then there is no revenue to expand hopitals or recruit and pay nurses from other states.

    There is plenty of sick patients to care for. Since PA’s and NP’s see most of the nonacute stuff my day is spent intubating, putting in central lines, working up 88 year old people with abdominal pain. A couple of resuscitaions simultaneously will occupy all resources and increase the wait for your belly pain a couple of hours.

    One thing that is starting to happen at some ER’s as well is a rapid medical evaluation and if it is determined that you do not have an emergency condition you are sent away without treatment and told where some urgent cares are. Not great for customer service but saves the bottom line.

  • Anonymous

    noname:
    hearing a dr. complain about a 7 hour er wait surprises me since I live in one of the largest cities in this country–good luck getting into any er here under 10 hours unless you are critical. can’t tell you how many times i personally or someone i know have been very ill or had ill children and still waited at least 8 hours. Where I live, 7 hours is not unreasonable at all. A relative of mine is an ER dr. at a large inner city trauma center, they run up to a 24 hour wait time in their er.

  • tflm

    Government targets in the UK state that patients should be seen within 4 hours in A&E (the name for ER). I walked in a hospital that was so good at hitting its targets people were choosing to come to our dept from surrounding cachement areas. Do I think that it is a good idea for these targets – I’m not sure. We see over 80,000 patients a year with only 15 doctors in total (generally between 2 and 6 doctors working at a time) and have basically become a triaging service. Everything the hospital does is skewered to hit government targets. If you have a disease which is auditted good for you but everyone else just gets pushed back in the queue. I do think that spouting certain figures is pointless and clinicains should be left to make their management decisions with minimal bureacracy. If they paid for ten times the number of doctors waiting times would be almost negligible but then it would be a less efficient system with people being paid to sit on their arses. If you don’t want a wait you need the spare capacity around.

  • Martin Jensen

    “In an area of good demographics where a large portion of patients actually pay their bill then it behooves hospitals and physicians to become more efficient in order to compete. In areas where demographics are poor why would hospitals and doctors want to compete for the non-paying illegal alien patients?” This makes absolutely no sense. The ability to treat patients more effectively and efficiently (which is, by the way, how you reduce ER wait time) is more important in low-income care settings. Nursing time is used more effectively, which reduces the impact of the nursing shortage. Administrative time is used more effectively, reducing the cost of labor per visit. Safety net reimbursement, when available, is closer to the cost of care. Saying that efficiency doesn’t matter in a cash-poor community is like saying mileage doesn’t matter when the price of gas goes up.