Comments on: Lawyer: "I want my doctor to use defensive medicine" http://www.kevinmd.com/blog/2007/02/lawyer-i-want-my-doctor-to-use.html Tue, 14 Feb 2012 17:18:00 +0000 hourly 1 By: Anonymoushttp://www.kevinmd.com/blog/2007/02/lawyer-i-want-my-doctor-to-use.html#comment-72134 Anonymous Thu, 22 Feb 2007 17:55:00 +0000 http://clients.emmense.com/kevinmd/2007/02/lawyer-i-want-my-doctor-to-use-defensive-medicine.html#comment-72134 Anon at 5:36, this has been discussed ad nauseum. If you are interested, you can look it up yourself.<br/><br/>Select a test, say, cat scan and look up the amount of radiation and chance it can cause cancer some years down the line. Check it up for kids. Keep in mind that the effect of radiation is cumulative. Now think about how high a chance that you have some condition you want the doctor to test your kid for must be like for you to accept this risk. Do the same for multiple X-rays for kids.<br/><br/>Select any other test you like and look up the percentage of false positives. Look up what test(s) is/are likely to be done in case of a false positive and the chance of complications from a riskier test (I believe there was some mention of EKG sometime in this forum last year with actual numbers). Multiply the risk of false positive by the risk of complications from additional test(s). Here is your risk of suffering harm if you take the test in the first place.<br/><br/>For other tests, like PSA, go to NIH or USPSTF websites and look up "harms of testing". Also look up "overdiagnosis". <br/><br/>Keep in mind that risks go up with the number of tests.<br/><br/>Now consider the chance you have the desease the doctor is testing you for. Keep in mind that when they talk about "defensive" testing they mean cases in which your chance of having this desease is really small. Think about how much risk you are willing to tolerate for say 1/10,000 chance of benefit. Anon at 5:36, this has been discussed ad nauseum. If you are interested, you can look it up yourself.

Select a test, say, cat scan and look up the amount of radiation and chance it can cause cancer some years down the line. Check it up for kids. Keep in mind that the effect of radiation is cumulative. Now think about how high a chance that you have some condition you want the doctor to test your kid for must be like for you to accept this risk. Do the same for multiple X-rays for kids.

Select any other test you like and look up the percentage of false positives. Look up what test(s) is/are likely to be done in case of a false positive and the chance of complications from a riskier test (I believe there was some mention of EKG sometime in this forum last year with actual numbers). Multiply the risk of false positive by the risk of complications from additional test(s). Here is your risk of suffering harm if you take the test in the first place.

For other tests, like PSA, go to NIH or USPSTF websites and look up “harms of testing”. Also look up “overdiagnosis”.

Keep in mind that risks go up with the number of tests.

Now consider the chance you have the desease the doctor is testing you for. Keep in mind that when they talk about “defensive” testing they mean cases in which your chance of having this desease is really small. Think about how much risk you are willing to tolerate for say 1/10,000 chance of benefit.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/02/lawyer-i-want-my-doctor-to-use.html#comment-72105 Anonymous Thu, 22 Feb 2007 00:31:00 +0000 http://clients.emmense.com/kevinmd/2007/02/lawyer-i-want-my-doctor-to-use-defensive-medicine.html#comment-72105 Once again this makes obvious the problems created when the payment for an individual private good, healthcare, is collectivized. Once again this makes obvious the problems created when the payment for an individual private good, healthcare, is collectivized.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/02/lawyer-i-want-my-doctor-to-use.html#comment-72099 Anonymous Wed, 21 Feb 2007 22:36:00 +0000 http://clients.emmense.com/kevinmd/2007/02/lawyer-i-want-my-doctor-to-use-defensive-medicine.html#comment-72099 I frequently hear, "that tests have risks too." Does anyone know what, statistically speaking, are these feared risks for the top 10 most often ordered tests, both inpatient and outpatient? I frequently hear, “that tests have risks too.” Does anyone know what, statistically speaking, are these feared risks for the top 10 most often ordered tests, both inpatient and outpatient?

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/02/lawyer-i-want-my-doctor-to-use.html#comment-72060 Anonymous Wed, 21 Feb 2007 00:50:00 +0000 http://clients.emmense.com/kevinmd/2007/02/lawyer-i-want-my-doctor-to-use-defensive-medicine.html#comment-72060 <i>Everyone wants everything when it is themselves or their family. The trouble has to do with who is paying the freight.<br/></i><br/>I think the reason this lawyer and the like want "defensive medicine" is that they don't understand that it is not just about the money and that tests have risks too. So maybe if you guys put more effort in educating public, than maybe there'll be fewer people sharing this lawyer's sentiments.<br/><br/>Also, we don't really know much about the details of the case this lawyer cites to determine if his definition of defensive medicine is the same. Everyone wants everything when it is themselves or their family. The trouble has to do with who is paying the freight.

I think the reason this lawyer and the like want “defensive medicine” is that they don’t understand that it is not just about the money and that tests have risks too. So maybe if you guys put more effort in educating public, than maybe there’ll be fewer people sharing this lawyer’s sentiments.

Also, we don’t really know much about the details of the case this lawyer cites to determine if his definition of defensive medicine is the same.

]]> By: AleShttp://www.kevinmd.com/blog/2007/02/lawyer-i-want-my-doctor-to-use.html#comment-72058 AleS Wed, 21 Feb 2007 00:34:00 +0000 http://clients.emmense.com/kevinmd/2007/02/lawyer-i-want-my-doctor-to-use-defensive-medicine.html#comment-72058 Surely he wants it... but has he already deserved it? And it's normal, all should be in harmony, what have you made for it? - that's a question<br/><br/>As said gasman "BIG" question :) Surely he wants it… but has he already deserved it? And it’s normal, all should be in harmony, what have you made for it? – that’s a question

As said gasman “BIG” question :)

]]> By: Gasmanhttp://www.kevinmd.com/blog/2007/02/lawyer-i-want-my-doctor-to-use.html#comment-72051 Gasman Tue, 20 Feb 2007 23:56:00 +0000 http://clients.emmense.com/kevinmd/2007/02/lawyer-i-want-my-doctor-to-use-defensive-medicine.html#comment-72051 Nurse, get me the BIG proctoscope... Nurse, get me the BIG proctoscope…

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/02/lawyer-i-want-my-doctor-to-use.html#comment-72047 Anonymous Tue, 20 Feb 2007 23:21:00 +0000 http://clients.emmense.com/kevinmd/2007/02/lawyer-i-want-my-doctor-to-use-defensive-medicine.html#comment-72047 Everyone wants everything when it is themselves or their family. The trouble has to do with who is paying the freight. Everyone wants everything when it is themselves or their family. The trouble has to do with who is paying the freight.

]]> By: Anonymoushttp://www.kevinmd.com/blog/2007/02/lawyer-i-want-my-doctor-to-use.html#comment-72037 Anonymous Tue, 20 Feb 2007 20:49:00 +0000 http://clients.emmense.com/kevinmd/2007/02/lawyer-i-want-my-doctor-to-use-defensive-medicine.html#comment-72037 Kevin, you do realize he's using a different definition than you of defensive medicine, don't you? Kevin, you do realize he’s using a different definition than you of defensive medicine, don’t you?

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