Comments on: "The incredible amount of wasted dollars in medicine due to worry about liability drives health care costs higher" http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html medical blog Sun, 22 Nov 2009 07:50:13 -0500 http://wordpress.org/?v=2.8.4 hourly 1 By: Diora http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70630 Diora Fri, 19 Jan 2007 22:02:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70630 <i>Are people with AIDS less human to you. Do they not deserve gastric bypass or should we just take them off their drugs so that the AIDS can thin em down? Is that what you are saying..</i><br/>She said there was no evidence of its being efficacious. Do you disagree with this statement? If so, do you have any evidence that this procedure will result in saved years of life? Do you have any evidence that the risks of the procedure itself will not be greater than the benefit?<br/><br/><i>Interesting how likelihood matters when it is physicians making decision outside of their expertise (law), but does not matter when patients "request" treatments and procedures outside of theirs (medicine). Does a 1 in 100,000 chance of post-prandial, non-exertional chest pain in a healthy 25 year old that turns out to be an MI result in a no-cause order at trial, or is the likelihood irrelevant? </i><br/>Shouldn't it matter in both cases? If the physician is making this choice without informing the patient of the likelyhood and possibly making a patient pay for it (in case of high deductible plan or an uninsured patient), how is it different from theft?<br/><br/>If a patient is the one who is making the choice, who is paying for it? The patient or the taxpayers? If the patient, he has a right. If it is the taxpayers, maybe the money would be better used elsewhere?<br/><br/>Also, what is the likelyhood of a false positive during this procedure? What is the likelyhood of harm resulting from more invasive test that would follow this false positive? Given these two numbers is the absolute probability of harm in this case greater than the probability of benefit? If so, don't you think the patient has a right to know? Are people with AIDS less human to you. Do they not deserve gastric bypass or should we just take them off their drugs so that the AIDS can thin em down? Is that what you are saying..
She said there was no evidence of its being efficacious. Do you disagree with this statement? If so, do you have any evidence that this procedure will result in saved years of life? Do you have any evidence that the risks of the procedure itself will not be greater than the benefit?

Interesting how likelihood matters when it is physicians making decision outside of their expertise (law), but does not matter when patients “request” treatments and procedures outside of theirs (medicine). Does a 1 in 100,000 chance of post-prandial, non-exertional chest pain in a healthy 25 year old that turns out to be an MI result in a no-cause order at trial, or is the likelihood irrelevant?
Shouldn’t it matter in both cases? If the physician is making this choice without informing the patient of the likelyhood and possibly making a patient pay for it (in case of high deductible plan or an uninsured patient), how is it different from theft?

If a patient is the one who is making the choice, who is paying for it? The patient or the taxpayers? If the patient, he has a right. If it is the taxpayers, maybe the money would be better used elsewhere?

Also, what is the likelyhood of a false positive during this procedure? What is the likelyhood of harm resulting from more invasive test that would follow this false positive? Given these two numbers is the absolute probability of harm in this case greater than the probability of benefit? If so, don’t you think the patient has a right to know?

]]> By: Rich, MD http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70580 Rich, MD Thu, 18 Jan 2007 21:22:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70580 The first commentor above wrote: <br/><i>And if it is purely fear of liability, how do we know that fear is justified? What exactly are physicians afraid of and what is the likelihood of their fears being realized? If they don't know, should we be making policy based on their lack of knowledge? </i><br/><br/>If you change "liability" to serious illness" and "physisan" to "patient", you get:<br/><br/><i>And if it is purely fear of <b>serious illness</b>, how do we know that fear is justified? What exactly are <b>patient</b> afraid of and what is the likelihood of their fears being realized? If they don't know, should we be making policy based on their lack of knowledge? </i><br/><br/>Interesting how likelihood matters when it is physicians making decision outside of their expertise (law), but does not matter when patients "request" treatments and procedures outside of theirs (medicine). Does a 1 in 100,000 chance of post-prandial, non-exertional chest pain in a healthy 25 year old that turns out to be an MI result in a no-cause order at trial, or is the likelihood irrelevant? The first commentor above wrote:
And if it is purely fear of liability, how do we know that fear is justified? What exactly are physicians afraid of and what is the likelihood of their fears being realized? If they don’t know, should we be making policy based on their lack of knowledge?

If you change “liability” to serious illness” and “physisan” to “patient”, you get:

And if it is purely fear of serious illness, how do we know that fear is justified? What exactly are patient afraid of and what is the likelihood of their fears being realized? If they don’t know, should we be making policy based on their lack of knowledge?

Interesting how likelihood matters when it is physicians making decision outside of their expertise (law), but does not matter when patients “request” treatments and procedures outside of theirs (medicine). Does a 1 in 100,000 chance of post-prandial, non-exertional chest pain in a healthy 25 year old that turns out to be an MI result in a no-cause order at trial, or is the likelihood irrelevant?

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70563 Anonymous Thu, 18 Jan 2007 15:01:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70563 What are you even talking about... it is hard to follow the point you are trying to make with examples like "gastric bypass for people with AIDS." Are people with AIDS less human to you. Do they not deserve gastric bypass or should we just take them off their drugs so that the AIDS can thin em down? Is that what you are saying... What are you even talking about… it is hard to follow the point you are trying to make with examples like “gastric bypass for people with AIDS.” Are people with AIDS less human to you. Do they not deserve gastric bypass or should we just take them off their drugs so that the AIDS can thin em down? Is that what you are saying…

]]> By: nurse ratchett http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70546 nurse ratchett Thu, 18 Jan 2007 02:23:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70546 Well, she4 said the doc's wouldn't like it- and they don't. Hence the reason you see no line to jump on the evidenced based bandwagon.<br/>Let me tell you right now- I DO work for an insurance company, and the waste is rampant. SPECT Scans for 21 yo with no history but c/o chest pain after an URI and smokes. No FH of CAD, etc. Thats a liability issue, or as the genius and experienced nurse pointed out, a chance for upcoding so the office owned scanner can make some money.<br/>Ridiculous.<br/>Gastric bypass for obese pateints with AIDs? Why? Because they want it, and the surgeon dictating the H&P can upcode and justify it? I don't see the evidnce for that being efficacious.<br/>Why is it so angering to some physicians that nurses point out flaws in your practice? If it leads to BETTER care for all of us, at lesser cost, what could possibly be the issue aside from potential loss of income? If you're ethical, it wouldn't even be a concern. Well, she4 said the doc’s wouldn’t like it- and they don’t. Hence the reason you see no line to jump on the evidenced based bandwagon.
Let me tell you right now- I DO work for an insurance company, and the waste is rampant. SPECT Scans for 21 yo with no history but c/o chest pain after an URI and smokes. No FH of CAD, etc. Thats a liability issue, or as the genius and experienced nurse pointed out, a chance for upcoding so the office owned scanner can make some money.
Ridiculous.
Gastric bypass for obese pateints with AIDs? Why? Because they want it, and the surgeon dictating the H&P can upcode and justify it? I don’t see the evidnce for that being efficacious.
Why is it so angering to some physicians that nurses point out flaws in your practice? If it leads to BETTER care for all of us, at lesser cost, what could possibly be the issue aside from potential loss of income? If you’re ethical, it wouldn’t even be a concern.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70541 Anonymous Thu, 18 Jan 2007 00:46:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70541 I have been to deposition 10+ times. Only once was the nurse ever brought into it and that was because it was a sexual assault case and she was part of the evidence collection.<br/><br/>The lawyers generally leave the nurses alone. Only as an agent of the deep pocket hospital are the lawyers concerned with nursing. I have been to deposition 10+ times. Only once was the nurse ever brought into it and that was because it was a sexual assault case and she was part of the evidence collection.

The lawyers generally leave the nurses alone. Only as an agent of the deep pocket hospital are the lawyers concerned with nursing.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70525 Anonymous Wed, 17 Jan 2007 20:34:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70525 "Spoken by a nurse who will never be the person that gets sued!"<br/><br/>Yes, but the nurse is going to be dragged into court right along with you. I can think of a lot of things I would rather be doing than having to testify in a malpractice case. “Spoken by a nurse who will never be the person that gets sued!”

Yes, but the nurse is going to be dragged into court right along with you. I can think of a lot of things I would rather be doing than having to testify in a malpractice case.

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70521 Anonymous Wed, 17 Jan 2007 19:48:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70521 Lots of speculation, straw men and very loose generalizations in this nurse's article. Now if you want to show me a prospective study that compares diagnostic code with CPT codes for costly and allegedly "over-ordered" exams like CT and MR and cross-compare that with income (Hey, I'll even accept "income" abstracted from zip code), then I'll beinterested. Until then, this article belongs in the shut-up box. Lots of speculation, straw men and very loose generalizations in this nurse’s article. Now if you want to show me a prospective study that compares diagnostic code with CPT codes for costly and allegedly “over-ordered” exams like CT and MR and cross-compare that with income (Hey, I’ll even accept “income” abstracted from zip code), then I’ll beinterested. Until then, this article belongs in the shut-up box.

]]> By: The Independent Urologist http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70519 The Independent Urologist Wed, 17 Jan 2007 19:39:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70519 Your post deserves 1 response: BULL! Your post deserves 1 response: BULL!

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70518 Anonymous Wed, 17 Jan 2007 19:27:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70518 Spoken by a nurse who will never be the person that gets sued! Spoken by a nurse who will never be the person that gets sued!

]]> By: Anonymous http://www.kevinmd.com/blog/2007/01/incredible-amount-of-wasted-dollars-in.html/comment-page-1#comment-70503 Anonymous Wed, 17 Jan 2007 18:01:00 +0000 http://clients.emmense.com/kevinmd/2007/01/the-incredible-amount-of-wasted-dollars-in-medicine-due-to-worry-about-liability-drives-health-care-costs-higher.html#comment-70503 Is it defensive medicine, or if you asked the patients, would they want these tests performed? If the patients want it and their insurers are willing to pay for it, how is that the fault of those with malpractice claims?<br/><br/>And if it is purely fear of liability, how do we know that fear is justified? What exactly are physicians afraid of and what is the likelihood of their fears being realized? If they don't know, should we be making policy based on their lack of knowledge? Is it defensive medicine, or if you asked the patients, would they want these tests performed? If the patients want it and their insurers are willing to pay for it, how is that the fault of those with malpractice claims?

And if it is purely fear of liability, how do we know that fear is justified? What exactly are physicians afraid of and what is the likelihood of their fears being realized? If they don’t know, should we be making policy based on their lack of knowledge?

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