Was there a survey where someone called Drs. or came around to them and wanted to know how many defensive tests they order in a day? Week? Month? And the Drs. answered that question honestly, right?

They don’t say, “yes, I ordered all these tests to protect myself but don’t tell the ins. companies.” Why do you think they all post anon here?

Surely, you can’t be serious !?!

Not sure what point of the 20% stat is, though.

PS: I am not anon 5:05.

How does defensive medicine contribute to the number of uninsured?

Is there a study which tells us how much less defensive medicine is done in states with “reform” and states without? Is health insurance cheaper in those states? Have health insurers promised to lower premiums if defensive medicine is reduced?

Considering defensive medicine, even at its highest guessed amount, is less than 10% of all medical expenditures, and presuming that we could lower it to $0, exactly how many people will be insured then?

Do tell.

Whatever the reason for testing, the fact is that tests are not risk-free. There is always a balance between the chance of individual benefit and chance of harm, even for tests that are shown to save lives.

Whether the reason is malpractice or a genuine belief in the test – the result for a patient is the same. In most cases – there is no effect except for cost. A few might even benefit. But a few more will be harmed (and in many cases the number of those harmed will be higher than the number of those who benefit). Even if a test is shown to save lives, the probability of an individual benefit is often extremely small and in some cases a balance of benefit/harm is subjective, so a reasonable person may decide to refuse a recommended test. If a test is not shown to save lives – like urinalysis, PSA or routine X-rays for smokers (not that I care much about smokers) the risks are at least as great than a chance of an individual benefit (if any). I don’t know if you are a doctor or a patient, but I think you are seriously underestimating the risks. If false positives and overdiagnosis is no big deal to you – great, but it doesn’t mean that it is the same for others.

Generic solutions are fine in the long-term – and I am all for them, but they don’t make a difference for an individual here and now.

Incidentally, the people will not change their opinions unless they stop believing that more testing=better care. And this information comes from everywhere -TV, newspapers,radio, internet. But journalists don’t just invent it. For the most part they get it from the doctors. So doctors are not entirely blameless here. Just pick a few non-recommended tests and google. You’ll find a zillion websites which recommend them, and many of those websites are written by a doctor or at least list a few names of doctors as reviewers.

In my experience doctors are not ordering ridiculous tests that have no benefit or that put a patient at risk for no potential benefit just to be defensive. I think doctors consider ruling out diagnoses that are a bit unlikely when without the malpractice enviornment we have now, those less likely diagnoses may not have been taken very seriously at all, and most likely with no detriment to the patient.

Pressure from health care providers will not encourage malpractice reform by itself. There has to be political pressure by the general public, but it won’t happen until people start to understand what a huge problem this is, and how it it contributes to the escalating cost of health care, the number of uninsured patients etc.

Well, some of us are. I speak doctor like B. Billingsly speaks jive.

I don’t have a test unless I know what it is, why it’s being done, what the doctor is looking for. And even a total rube layman can look anything up these days.

Any doc of mine gets second-guessed every inch of the way, not that I won’t completely agree with him most of the time. I know just what to ask, and it ocassionally results in true happiness on the part of the doctor, but sometimes irritation or a look of fear, depending on the doc.

I’m not an evidence-based bot, though. I am not a cow in a herd, but an individual and expect my care to be very tailored, and with two pairs of pants. And since I can make it so, I do.

What if instead of an EKG they’ll send you for some invasive procedure that has inherent risks of permanent harm? You may suffer your whole life from this procedure done for something you had 1 in 10000000 chance of having. You may even die from an invasive test. What is good odds for a doctor in terms of malpractice risk is not necessary good odds for you. 1 in a million chance of having your life saved is great if the risk is 0, but what if this risk is 1 in 1000? These are just random numbers, btw, I am not thinking of any specific test.

Similarly, a 2 year old sent for repeated X-rays or cat scans he/she doesn’t need can have cancer 10 years down the line. For a doctor trying to avoid malpractice the choice is clear. For a parent, maybe the probability of each outcome is more important.

The question I have is about talking to a doctor. How can we as patients convey to the doctor our refusal to have a specific test/screening without offending the doctor, without demonstrating our lack of trust while simultaneously showing that we truly made an informed decision and not one based on irrational fears or misinformation. This is something I constantly struggle with if I found some information. Shall I bring it up? How shall I word it? I don’t want to offend the doctor, I don’t want to waste his/her time, but I do know that I don’t want defensive tests and that I want to make my own decisions about screening. I think the main reason my blood pressure goes up before/during doctor’s visits just from thinking about these things.