Almost half of physicians order tests to avoid lawsuits

Yes. You were asking me, right?

But does it help avoid lawsuits? How can you tell? Have you ever detected a problem you wouldn’t otherwise have?

Many physicians won’t care whether it’s working on a “macro” level or not. Self-preservation and lawsuit-avoidance behavior will always be strong influences in physician decision making.

Think about it. Why worry about missing that 1 in 100 case by not testing versus sleeping peacefully at night testing for that 1 in 100 case?

There is currently zero disincentive to overtest. Capitation is falling by the wayside, there is a predominant fee-for-service system, and patients positively respond to physicians being “more thorough” by ordering more tests.

Talk about a lopsided risk/reward structure.

What would you do?

Kevin

I have estimated that I spend with a stroke of pen 2-3.5 million dollars a year on defensive medicine. I am far from the most risk averse person in my group. Maybe if my salary was one million dollars I might be willing to take the risk and save the remaining 1-2 million dollars to society and the healthcare system. But as Kevin said there is absolutely no incentive to practice with more risk than you have to.

But has anyone ever discovered anything they otherwise wouldn’t have as a result of what they considered overtesting?
Just a guess: probably, including some stuff that would’ve never threatened lives of patients if remained undetected. But because it was discovered they went through possibly toxic treatments. And suffered side effects maybe for lifetime. And a really large number of patients got caught in an endless cycle of more and more invasive and risky tests because of numerous false positives and inconclusive results. So very few win, a lot more loose.

“But has anyone ever discovered anything they otherwise wouldn’t have as a result of what they considered overtesting?”

Yes, frequently. Sometimes it means something, sometimes it doesn’t.

Interestingly, when a lawyer or lawyers family is being treated they often ask for the most testing. “Don’t you think we should get a CT, MRI, ANA titre for lupus, etc….”

They do (hopefully); but as they say, nobody ever gets sued for overtesting. You get a false positive – “doctor found something, my doctor is thorough”, you got (maybe) diagnosed with some early desease which possibly would’ve never caused you any harm – “my life was saved”. Because there is no way to say if something they found would’ve ever threatened your life.

Do you think all of the recommended tests are completely risk-free? Think again. The only difference is some evidence that there are people who benefit greatly from it. But the chance of you personally benefitting is extremely small.

“Of course we know, self preservation and sleep at night come first.”

You couldn’t sleep at night if you relied on your professional judgment solely?

If you’re not sure it works, isn’t your confidence a false confidence?

People use to go to doctors and they diagnosed you by “touching you” (odd concept I know) pushing, pulling listening, smelling…RARELY did you get sent to a specialist. If you did you have reason to worry because it was not the norm for that to happen. You young guys act like you don’t really practice medicine. Do you know how? Does med school actually teach how to be a doctor anymore. Or, do they just teach how to order tests and refer to all these specialist to spread around liability?

One has to wonder if you could push on a persons belly and tell is the spleen is swollen. I don’t know if mine is swollen or not but I know it hurts when I read this BS.

Suppose a patient presents with a lesion but denies any risk-enhancing behaviors (smoking, drinking, etc.) You do a surgical biopsy, send the results to the lab, and they come back benign. But the lesion recurs within months, you don’t know why, so you do another surgical biopsy. Same results, and again, recurrence within months.

How many times do you repeat the surgical biopsy as a defensive measure? If you elect to discontinue treatment at some point, how do you handle it — considering that you’ve already done multiple biopsies and have probably scared the bejeesus out of the patient by now?

And if the patient begins to suspect that s/he is on the receiving end of defensive medicine and wants to discuss it with you, then what? Do you have that talk? Do malpractice fears skyrocket, causing you to act in some other defensive fashion?

I think the 50% number is way low. I’d say more like 95-99% of physicians order defensive tests based on my 20+ years as a practicing radiologist. I don’t blame them for doing it and it has made me a ton of money. It’s a win-win situation for everybody but the patient.

I had to tell a father today that his two children, age 2 and 6, both had tested positive for HIV. All he could say to me was “but I prayed every day this week that the tests would be negative”. I couldn’t help him, and i died inside knowing there’s so little I can do. Then I had to move on to the next patient. And to think I have to spend much of my week ordering defensive tests to keep away the maggots that are attorney’s when instead I could be using my time helping families in need like this. No-one seems to understand (or care) what the maggots are doing to our time and our health care system. This family (poor immigrants) can’t get the health care they need, but I can order an MRI on a mild headache “just in case”. It just isn’t right.

11:23,

I’m not sure but I think it might be Bush’s fault.

Can a Physician “86″ a patient if the patient refuses un-needed medical tests. Sort of like you can afford it why not!