More tidbits from the ATLA president. The ignorance is worse than I thought:
And you talk about defensive medicine; one of the things that astonishes me is the extent to which people — and, unfortunately, the press — are willing to buy into these wild statement that are made. Have you ever gone to your doctor and had your doctor say, ‘You know, there’s a test that I probably ought to give you. I don’t think it’s necessary, but I’m afraid you’ll sue me if I don’t?’ And do you know anybody whose doctor has ever said anything like that to them? Or do you know anybody whose doctor has ever given them an unnecessary test?
Granted, defensive medicine is uncommonly phrased like that, although it does happen. Often, defensive tests are phrased like this: “I don’t think that your headache is anything to worry about, but ‘just to be on the safe side’ (or ‘just to be complete’, or ‘just so we’re not missing anything’), let’s do a CT scan to rule out a tumor.” Patients will then be appreciative your thoroughness and completeness. It’s really quite a positive-reinforcing phenomenon.
Mr. Suggs, there is an open invitation for you to read this blog. Open your eyes to reality, and perhaps you’ll sound less foolish in the future.
Related posts:
- Defensive medicine is aggressive
- Defensive medicine op-ed reaction
- Lawyer: "I want my doctor to use defensive medicine"
- Defensive medicine
- Defensive medicine in the ER
- Defensive medicine in the news
- Patient perceptions and defensive medicine
KevinMD.com on Facebook
{ 45 comments }
It isn’t ignorance. It is deliberate obfuscation on the part of the president of the extortionists’ society to minimize the chance for reform that’ll kill their golden goose.
Is his name really Suggs? I would think that was illegal? Tantamount to “Mr. Fukyu” or “Mr. P. Oon Tang”? Or even “Biggus Dickus”?
So what’s the downside of defensive medicine if the physician feels they are doing it just to be complete or are doing it just to be on the safe side? And what reform would change that and why?
Anon 3:38, your questions have been discussed in this blog a few times. I think that instead of asking, you can contribute by writing your opinion and then we can have a discussion. Thanks. -amd
Actually, those questions have never been answered. Which is odd, because you’d think physicians would have some knowledge of what reforms reduce “defensive medicine” given the variety of reforms tried by the states. Surely someone has checked to see if health care expenditures in those states for certain diagnostic tests commonly associated with “defensive medicine”?
Are physicians not curious as to these questions? I can’t find any large scale studies on the subject, can you?
My opinion is that defensive medicine debates are somewhat pointless, because it is unquantifiable. So any discussion of it is an abstraction, but again, if there are studies on the issue, I’d love to see them. I would think Kevin would as well, given how much he beats the drum.
Kevin, don’t you find it somewhat ironic that you would accuse someone else of being “ignorant” of your profession considering the rash of uninformed opinions held by physicians, including yourself, about the law?
“considering the rash of uninformed opinions held by physicians, including yourself, about the law?”
Uninformed according too….oh yeah you, the one who directly profits from a system that is not good for most patients (read crapshoot)or docotors…..only you. Thanks for the info
Kevin,
You can’t define “defensive medicine” so I can hardly think you can criticize those who belief it doesn’t exist.
Define your terms–then we can talk. Otherwise, you’re simply a ranting, spoiled, arrogant doctor.
Anon 9:24,
Defensive medicine has been well-defined in many instances on this blog. I’ll repost here for your benefit:
“Defensive medicine refers to changes in the way care is delivered – the ordering of unnecessary tests, for example, or ceasing to perform high-risk procedures – which are motivated by fear of litigation, rather than good medical practice.”
Thanks,
Kevin
“I would imagine it’s quite a big help to a patient who receives a settlement or a verdict and would otherwise be facing mountains of unpaid bills both past and future, wouldn’t you?”
Let’s see we have a system in which:
A: The majority of trial’s end up with a verdict for the doctor’s
B: The majority of people who ARE injured do not recieve any compensation
How about you tell me how this is a good system (for anyone but you that is)?
Being a student in school, I find it hilarious to read comments on popular blogs. Is it just me or do the comments always seem to devolve into a name-calling affair that accomplishes nothing. It’s like people refuse to believe others might have different points of view based on their life experiences.
I always laugh when people criticize Kevin (or call him names – spoiled, arrogant to name just a couple) for simply putting forth his beliefs and ideas.
/end criticism
/begin MY THOUGHTS on “defensive medicine”
In today’s world patients demand 100% accuracy from a science that is in no way 100% accurate. Patients equate more testing with more accuracy. I attribute this to increased awareness (not knowledge) of various medical procedures gleaned from TV, the Internet, and other various sources. Patients today demand more testing.
In the past doctors doctors dealt with patients that were less informed and maybe less demanding. Doctors wouldn’t need to order test Y to rule the 1 in 1000 chance of medical condition Z, because the cost far exceeded the benefit and patients trusted the doctor’s judgment.
Nowadays with a negative outcome patients feel as though something was missed, because doctors have all sorts of amazing treatments to cure any type of medical problem or at least that’s what patients are lead to believe (see House, MD on the Fox Network). They want everything and anything done to help them even if the chance of success is infinitesimal and procedure is overly expensive.
If I was taught in medical school not to order an unnecessary test because there was only a small percentage of a benefit, that would not be how I practiced in today’s world. If I’m penalized by a lawsuit for not over testing, but I’m not penalized for over testing (I might even be rewarded monetarily by doing more procedures), then I’m going to over test like crazy. I’d be a fool not too.
I find it hard to believe that there wouldn’t be some sort of “defensive medicine” being practiced by doctors. It might not be something that is easily quantifiable, but I wouldn’t say it’s a complete hoax.
/end MY THOUGHTS
Feel free to call me names, but please follow up with ideas, suggestions, comments on the topic at hand.
J (soon to be EMT and college grad)
J,
No one is saying it is a complete hoax. It’s simply that Kevin’s definitions always come down to “whatever I say it is”, which is essentially meaningless.
What’s more, he and other physicians beat the drum to what end? What proposal would reduce defensive medicine? They back caps extensively, yet we’ve had caps for decades now – are those states with them showing health care savings?
The criticism of the physicians who constantly cry “defensive medicine” is simple – that they continue to back solutions which they have made no effort to determine if they work. Even using their nebulous definition of the problem.
“A: The majority of trial’s end up with a verdict for the doctor’s
B: The majority of people who ARE injured do not recieve any compensation
How about you tell me how this is a good system (for anyone but you that is)?”
If every case ended in a trial, you’d have a point. However, the vast majority don’t, so you don’t.
Are you saying there are many, many more people injured by providers’ negligence and you want them to receive compensation?
anon 11:57pm,
I’ll agree with you that doctors shouldn’t be using “defensive medicine” as a reason for instituting injury caps. That’s not an appropriate solution. With caps you’re simply making it more difficult for injured patients to get compensation.
I will say that the current system for compensating injured patients sucks. Many more patients are injured than get compensated simply because their injuries are too small to warrant a trial. And there are those few that win big that probably don’t deserve their rediculous payouts.
I would like to see health courts with some sort of “no-fault” program. This would allow for more transparency in healthcare and hopefully fewer medical errors.
If only people acted for the benefit of society and not their own pockets. I doubt we’ll ever see a reasonable solution with emnity lawyers and docs have for each other. Of course I’d probably feel the same way if I was one or the other.
J
Tell me again how Lawyer’s aren’t the only ones who benefit from this broken medical profession.
I received a letter today about some class action that I have never heard of. It was against some ins. company. Not health ins. but one of the big companies none the less.
I have no clue as to why I’m included in the class action lawsuit, but it does state that if I sign my name and send it back before August 13th. I will most likely receive $225.00. Also could I please sign where it is highlighted that I approve the attorneys fees of 3.6 million dollars..huh?
It’s probably a suit you doctors filed (and asked for a jury trial) against health insurers for messing with your reimbursements. The attorneys have likely recovered in excess of $15 million for you, after spending their own time and their own money for years against very well funded opposition with no guarantee of winning.
If you don’t like it, opt out and you can pursue your claim yourself.
“In today’s world patients demand 100% accuracy from a science that is in no way 100% accurate. Patients equate more testing with more accuracy. I attribute this to increased awareness (not knowledge) of various medical procedures gleaned from TV, the Internet, and other various sources. Patients today demand more testing.”
I don’t doubt that there’s some truth in this, but it also overgeneralizes in much the same way that you’ve criticized others for their posts.
I’ve never approached a doctor demanding tests for anything. What I do hope for is reasonable amount of follow-up care. If something doesn’t look or feel quite right, I’d like to know that a knowledgeable doctor is going to keep an eye on it.
I’m not sure, but maybe that topic figures into this discussion of preventive testing somewhere. Is there any reason why doctors might prefer to order tests than to have several follow-up consults?
“If every case ended in a trial, you’d have a point. However, the vast majority don’t, so you don’t”
Is all you do for a living is play word games?
“Are you saying there are many, many more people injured by providers’ negligence and you want them to receive compensation”
Yes (although neither one of us know “how” many). I am saying the system is broken. The present system has “experts” who sing their tune based on who pays the bill. Jury’s who often don’t understand science or medicine. Payouts of which 40-50% go to administrative costs/lawyer fees. Cases of legitimately injured who don’t get taken because the payout isn’t adeqaute for the lawyer in a win. The only person who says this system works is you. Is it so hard to envison a system in which a panel of doctors (and medically educated nondoctors to keep the system honest) evaluates cases for merit? This can be done in such a way that the 7th amendment is not violated. Is it so hard to envision a system in which the whores that sing there tune based on who pays the bill are taken out of the system? Is it so hard to envison a system in which the vast majority of awards actually go to injured? Is it so hard to envision a system in which thoses injured but without high dollar injuries can have THEIR day? Is it so hard to envison a system in which the extreme confrontation (which you benefit from) is removed such that the merits of a case can be systematically and analytically evaluated? Is it so hard to envison a system in which when good doctors do injure patients, in which they can say “I am sorry” to the patient’s without being crucified by the legal system? The answers are out there and other countries have instituted some of them. However, there are strong forces that want to leave this system the way it is for their bottom line.
“Is all you do for a living is play word games? “
Since when did pointing out the errors in your claims become “word games”?
“The present system has “experts” who sing their tune based on who pays the bill. Jury’s who often don’t understand science or medicine.”
So why do all the independent studies show that the juries get it right the vast majority of the time? Do you just ignore inconvenient facts in reaching your conclusions?
“Payouts of which 40-50% go to administrative costs/lawyer fees. Cases of legitimately injured who don’t get taken because the payout isn’t adeqaute for the lawyer in a win.”
How has any proposal you have backed changed that? How are those proposals going to reduce the costs of an insurer’s overhead? Of getting physicians to testify and review cases for either side? Make it easier for a plaintiff to get a lawyer and cheaper as well? You’re full of criticisms, but light on solutions.
” Is it so hard to envision a system in which the whores that sing there tune based on who pays the bill are taken out of the system?”
To be replaced with who? The whores chosen by legislators who are lobbied by the AMA? Are we going to use some of those fine physicians (the majority) who wouldn’t dream of testifying against a colleague regardless of the facts of the case?
“Is it so hard to envison a system in which the vast majority of awards actually go to injured?”
Please, tell me what percentage you’re shooting for and how we would obtain it given the proposals you have backed? I look forward to hearing your solutions.
“Is it so hard to envision a system in which thoses injured but without high dollar injuries can have THEIR day?”
Same thing. I look forward to hearing about the proposal you’ve backed which results in insurers paying more people who are injured.
“The answers are out there and other countries have instituted some of them. “
Really, which ones?
“However, there are strong forces that want to leave this system the way it is for their bottom line.”
Sure, they are your own. You speak so nobly, but offer little other than damage caps in the way of solutions. Damage caps which you hope will save your insurer money which they’ll pass on to you. Please though, tell me about these solutions you speak so eloquently of. I agree, the cost is too high in the present system. Of course, the expert witness requirement is one imposed by. . . you guessed it, physicians! But I look forward to your solutions, after you’ve laid out your criticisms so well.
“In today’s world patients demand 100% accuracy from a science that is in no way 100% accurate. Patients equate more testing with more accuracy. I attribute this to increased awareness (not knowledge) of various medical procedures gleaned from TV, the Internet, and other various sources. Patients today demand more testing.”
I think this is true, but I think that doctors have at least a partial responsibility for this mindset.
There are some doctors that go on TV and recommend more and more testing; some doctors give interviews on TV programs about new great test X, or work as consultants for made-for-TV movies where somebody suffers a bad effect from doctors’ failing to diagnose Y on time. “Earlier is better” is the mantra one always hears on TV, one hears that condition X deemed not curable simply because there is no test that can detect it early enough, so people want tests. As if they can achieve immortality by just finding everything sufficiently early.
Also, a lot of what is said about defensive testing can be applied to regular recommended screening. For most recommended tests, thousands are tested to save one life. The risks and harms one can suffer are comparable as well. You may say that the cost is cheaper and the tests are less invasive, but then you are forgetting false positives. You can say that defensive testing isn’t proven to save lives; but logically if a defensive test you order has 1 in 1000 chance of helping, then you gets the same odds as in many recommended tests.
So a layperson constantly hears from doctors how he/she has to do X,Y,Z tests when they have no symptoms because there is 1 in 1000 (often after 10 years) chance it’ll save his/her life. Isn’t it natural for the same layperson to want a test that has 1 in 1000 chance of saving his/her life when this person has some symptoms? OK, most people don’t understand that the actual odds for preventive tests having only been told the relative risk reduction numbers, but they don’t understand the odds for defensive tests as well.
I think if the risks of testing has been made more known for all tests people would be much less likelly to demand more and more testing.
Just a humble opinion…
Well jeez CJDlite I think if you actually read anon 10:51 critically the answer would be obvious (clearly he/she wrote it that way). But that would actually involve thinking beyond your inherent bias. Also note, he/she never mentioned the word “malpractice caps”. Only you did. Also, I would freely give my time to serve as an “expert witness” and I think you would be surprised how many of us would if it wuld lead to real change in the present system.
As far as I can see, none of you have proposed anything.
Wouldn’t giving your time as an expert witness now relieve one of the main criticisms? What system do you expect will be so different? After all, many of you hate the way the experts at your state medical boards work.
“But that would actually involve thinking beyond your inherent bias. Also note, he/she never mentioned the word “malpractice caps”. Only you did.”
Show me a proposal on the table anywhere legislatively that you support and that doesn’t involve damage caps.
What you call bias is simply an acknowledgment of the facts. I don’t know why you are so unwilling to realize this.
“As far as I can see, none of you have proposed anything.”
Read for comprehension
“What you call bias is simply an acknowledgment of the facts”
Really you haven’t supported anything all you do is play devil’s advocate. That’s easy. How about you support your argument?
In response to an earlier post, here in MA we have a screening tribunal in which there is a judge, attorney, and physician in the field of the defendant, who decide whether there is a “legitimate question of liability.” Statistically, this holds up about 15% of cases. You can move forward if you lose at the tribunal, though you have to post $6,000 bond and the findings may be presented at trial. The doctors volunteer and only get $50 for the day, so are not biased and they don’t do it for the money.
There is also a $500,000 cap, which can be waived by the jury if there is disfigurement or other “special circumstances.” Fair enough.
It seems to work. We have more doctors per capita than anywhere else.
“Read for comprehension”
Show me your plan. Pithy sayings don’t constitute a plan.
It’s telling that any post about malpractice issues have doctors outraged and backing this or that proposal, all so insurers maybe hold the line on premiums, while meanwhile your reimbursements are dimished every year, something that has a clear effect on your bottom line.
Do you even know what the word pithy means?Doesn’t sound like it
pithy: Precisely meaningful; forceful and brief.
As far as plan there are alot of ideas even on this thread….if you bother to read them. But that’s not what your about anon./ You are about making one comment after another of minimal substance just to be devil’s advocate. That’s easy and you know it.
What’s your plan, Anon?
Your writing posting pattern is easy to follow on this site.
Interesting you post over and over again yet never have anything constructive to say.
OK I’ll bite
1: Suits being required to go through a panel of docs/and non docs first. Make this with teeth, not the Mass. or fomer Arizona model where if you don’t like the result it get’s ignored. Do it in such a way that patient’s who may have had an injury that lawyer’s won’t take due to the money get a hearing.
2: Getting rid of the present “expert opinion” model and requiring instate docs of the same specialty review cases and give opinions. Possibly senior docs on the way to retirement whose practice is slowing down.
3: Requiring health insurance company’s explain significant increases in premiums.
4: Require the federal government to make available the present VA computor system model on a national basis to minimize errors.
Do it in such a way that patient records are protected and give the “death penalty” to those insurance company’s that mess with this protection.
5: Institute a system of sanction or loser pays for those lawyer’s who repeatedly bring cases without merit. Make sure sanctions are readily available to the public on state bar websites.
6: Conversly, make sure board certification, malpractice cases (number of), and punitive board actions of docs are also readily available to the public on state medical websites. Arizona has a good model for those interested.
We can add more I am sure. The sad thing is if you talk to docs, many are willing to come halfway for a better system for all. Unfortuantely as ATLA head showed, the bar will not take one step. Notice how I never mentioned malpractice caps or violation of the 7th amendment.
I like your proposals. But I have a few questions.
1. Are you going to appoint advocates for those patients who can assist them in responding to the panel’s questions?
2. I agree
3. I agree
4. I agree
5. I agree
6. I agree
Why do you say ATLA won’t take steps? I realize you didn’t say caps, but your proposals haven’t made it very far in any legislature, have they? Physicians and their insurers have yet to offer a proposal in a legislature that doesn’t involve damage caps so why would you expect ATLA to meet halfway?
Be fair. Physicians have also proposed capping attorney fees for plaintiff’s (but not defense) counsel. It won’t reduce a verdict by a cent but is that even the point?
I’m digging the banter of the “for and against” reform. You can simplify the dabate by comparing the US experience to that of other countries. I know, I know we have the “best justice system in the world, blah, blah, blah”. Just spare me that, it don’t fly. Does the ATLA and the rest of the lawsuit industry really believe that doctors in the US are MANY time more negligent than doctors in Canada, UK, Japan or (take your pick… you get it)? Of course not. Well. there are MANY MORE lawsuits per physicians in the US than ALL of those countries (any country for that matter). Just answer the question, don’t obfuscate, redirect or quote the lame and not applicable I of Med “study”. The answers are simply loser pay, or special medical courts. I’m a cardiologist. Before we passed a tort reform constitutional amendment in my state, I spoke with attorneys on many occasions. I offered UNLIMITED liability,no caps, no gimmicks, in exchange for loser pays…. like every other advanced legal system in the world upholds. they would take anything else before that. If you have a great case, you shouldn’t have to worry about it. After reform (caps) were passed, lawsuit filings are down in my area by 90%. Have the doctors suddenly gotten better? Do the caps dissuade lawyers from taking “less lucrative” cases? If so, what about all those people that need “justice” :>)
You think defensive medicine is a myth? I order tests to CMAss DAILY! I know they’ll be more than likely negative. I need to protect myself. The ER docs are even more suit conscious. This is why a trip to the ERfor a headache will cost you 5-10K.
We simply aren’t fooled any more by the bogus “little guy” champion the lawyers keep preaching. It’s just too lame.
Shockly
If you haven’t figured out that universal healthcare in other countries is why there are fewer malpractice claims, then you’re not very informed.
Your state lawsuit filings are down because they filed many cases that would normally be getting filed now before the cap went into effect, even if they were going to settle. That large a reduction has nothing to do with the reforms.
You have made it harder for people without economic loss to find lawyers who can afford to take their case, though. Congratulations. I hope you feel like a big winner.
“If you haven’t figured out that universal healthcare in other countries is why there are fewer malpractice claims, then you’re not very informed.”
Fell free to show data that supports that statement.
Data that most other first world countries have universal health care? Really?
What’s the bulk of most malpractice awards? Medical bills, past and future. If you don’t have medical bills to worry about and your welfare system is fairly significant so your standard of living isn’t completely hitting bottom like in the US, why would you go to the trouble and ordeal of filing suit?
There is no data as to WHY people file fewer suits. They don’t poll people who don’t file. And since we don’t even track the number of malpractice suits in the US, it’s impossible to say.
You didn’t elaborate on any data that supports those countries with Universal Care have fewer suits. Samson in Norway has stated that the ease in filing claims results in increased claims (granted this is not quite the same as filing a “lawsuit” but it appears that is not something that can be readily done in Norway). He doesn’t give supporting evidence either. Without supporting evidence all you are providing is your opinion.
What I don’t understand is why medical schools are turning out all these young physicians with the idea that it’s not just good but expected of them to practice defensive medicine.
Dr. Kevin has only been in practice a couple years and he can talk nothing except malpractice and defensive medicine. That tells me he hasn’t been in medicine long enough to be burned out to the point of just not caring anymore.
He is still very much, I would think, under the influence of his training. so, why are doc’s being trained in this fashion?
It’s almost like you are being taught (brainwashed) to believe you have no self-worth and your education can’t be trusted. That you can’t rely on what you know to make proper diagnosis. There is a big difference between the experienced Doc’s and the newer ones.
Why are you not being taught how to have faith and trust your judgement as a physician? Do you learn any hands on at all? Is it just order every test you can think of and send to every specialist available?
Why is med school teaching everyone to distrust the public so completely?
One more question, why do you think the way you practice doesn’t effect negatively the health care crisis in this country? When you order all these high priced tests and procedures that you know are worthless what are you doing to the ins. companies, and to people’s out of pocket? You are surely adding more than your share of problems to a system that you repeatedly tell us is so broken. If ordering tests, refering to specialists, and having procedures done is what you call being a physician now then maybe the NPs and PAs can do your jobs!
“You didn’t elaborate on any data that supports those countries with Universal Care have fewer suits.”
That was your claim, not mine. The “claims” in Norway may well be the equivalent of “lawsuits” here. But you can’t give a straight across comparison of nations with very different situations in terms of how their legal systems operate and how health care is delivered.
Anon 10:30:
Your statement on 10:40
“If you haven’t figured out that universal healthcare in other countries is why there are fewer malpractice claims, then you’re not very informed.”
I am not being argumentative. I simply have never heard of any study that correlates universal care with claim number (the word “lawsuit” would probably not be analogous given differnce in countries legal systems). Feel free to elaborate.
It’s simple common sense. Again, the bulk of most awards in our system our medical bills. Take out the medical bills and why would 90% of the people go through the ordeal? Why would any plaintiff’s lawyer take the case?
Plus, some of those systems have no-fault compensation akin to our workers’ comp system. So again, no need to file a claim.
“It’s simple common sense”
Oh come now. Depending on the country, filing a claim maybe little more than filling out paperwork without the need to get a legal person involved at all. Do you honestly think you can say “it’s common sense” without any comparison data at all is appropriate?
It is common sense because he said so. This joker is not interested in figuring out relative malpractice rates and how they compare with ease of filing a claim and Universal care availability. he interested in playing perpetual devi’s advocate. Trust me, he will be all about “give me the evidence” when it supports his arguement..
There are no “relative malpractice rates” because private insurers aren’t paying the victim’s bill, the govt. is. There is nothing remotely relative about them at all. Which is why your comparisons to foreign countries are idiotic.
Oh come now do your really believe your own garbage. This may come as a shock to you but human beings are made and “fixed” the same way whether it be in the USA, Norway, or Brazil even if the legal systems are different. Just because in Norway the gov. picks up the majority of the claim while in the US it is individual insurance doesn’t mean you can’t figure out relative rates of claims (excuse the double negative).
By the way I though anon 7:35 had some excellent ideas on changing the status quo. Interesting how nobody really picked up on it.
Comments on this entry are closed.