More on how Kate Steadman doesn’t really know what she’s talking about. A medical student theorizes on the rise in defensive medicine:

If we used to feel 99.9% comfortable a patient doesn’t have an aortic dissection, we wouldn’t worry about it. But now, unless we feel 99.999% comfortable, we might as well check. What are the physician’s incentives? If he or she checks, he or she can feel even more comfortable (0.001% more comfortable) that the person is fine, and this means, in many physicians’ eyes, less chance of getting sued. What are the physicians disincentives? Having to interpret the results, good or bad, and hopefully some concern for medical costs, those that are either passed on to the patient or to their insurance company. But really, which will the physician choose?

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  • Anonymous

    Very good point. A 33 y/o patient presents with epigastric abdominal pain. It sounds/smells/feels like gastritis and I am pretty sure that it is gastritis. Would normally just treat the patient with H2 blockers or PPIs, etc. However, this patient thinks that he/she has cancer – how likely is that? Patient wants a CT scan. Who am I to argue? Patient doesn’t have to pay – has government entitlement, employer coverage, etc. – and why should I say no for that 1 in 100,000 to 1,000,000 chance that there is a malignancy? Defensive medicine…phooooey!

  • Anonymous

    Just make the patient pay for more of the costs–i.e., pit her cancer suspicion against a $3000 CT bill–and presto–defensive medicine dissappears.

    Doctors should simply present a menu–and let PATIENTS determine what level of confidence they want (and what level of risk they will assume that comes along with these tests)

    Thus, STOP belly aching about the tort system. Advocate Health Savings Accounts.

  • Anonymous

    Cancer with Epigastric pain? What the hell are you doing out there????Epigastric pain is Cardiac disease until proven otherwise. You start with a hospital admission to rule out cardiac causes, serum enzymes, EKGS, A cardiology consult, likely an invasive cardiac workup. Then you call GI. They recommend Ultrasound, prep for endoscopy, send H Pylori. While waiting stress echo can be done. Pt. has Endoscopy, while they are at it they do colonoscopy, maybe capsule endoscopy and Barium swallow with SBFT. All the while blood tests for ANCA, SLE, HIV, Hepatitis, Mono pile up. Only when all these things are negative do you pursue an abdoominal CT SCan. But remember sensitivity of CT scan is very low for tumours, so the patient will need a $5000 full body MRI. Now if only the patient took a mylanta.

  • Anonymous

    Putting aside the typical anonymice nonsense of the first and third commenters, the second makes an excellent point.

    Until health care is seen as something patients actually pay for, they are going to want the full treatment. Who can blame them? It’s no additional skin off their nose in terms of their premiums, which they figure will go up anyway.

    As it stands now, though, they have no incentive not to want the full battery of tests. And as the med student points out, what downside is there for physicians?

    Both bloggers, and maybe even Kevin, are right. Ms. Steadman is correct in saying that defensive medicine is impossible to quantify and tort reform will have little to no effect on it.

    Kevin believes there is defensive medicine, which is fine, yet so far he hasn’t given us an idea about how to reduce it.

    CJD

  • Kevin

    CJD,
    In my opinion, the following will reduce “defensive” medicine:

    1) no-fault
    2) health courts
    3) immunity for physicians practicing consensus-based evidenced-based medicine
    4) malpractice caps

    I actually think caps are the weakest solution of the four.

    Any one of these options will go a long way in influencing how physicians practice and order tests.

    Thanks,
    Kevin

  • Anonymous

    Kevin,

    How can you support a change in something when you don’t really know what’s wrong with it, if anything? Other than premiums are going up?

    It doesn’t appear physicians can say that the present system gets it wrong X% of the time with any consensus.

    And why aren’t there consensus based standards of care for the most common malpractice claims situations already? You would effectively have immunity if physicians could agree. For much less than the cost of a typical statewide campaign for caps, your insurers could provide their files to a group of you to develop this I would think.

    As for caps, they haven’t reduced defensive medicine or the cost of health care to any noticeable degree (much less a “long way) in any state so far, so why are you still a proponent?

    CJD

  • Anonymous

    “Putting aside the typical anonymice nonsense of the first and third commenters”

    That nonsense, unfortunately is what I (and my colleagues) all do for a living. Get away from my ass, sodomite!

  • Anonymous

    Anon 7:50 Why do you refer to so many people as being a sodomite? It makes people wonder why YOU are so drawn to the act of sodomy! Do you practice it?