Defensive medicine: Only in the USA

Scalpel with another real-world example:

She claimed that she discussed her symptoms with a relative in Guatemala who is a physician, and he told her to take some ibuprofen, and of course she got better. Why didn’t I think of that? Time for me to start looking for some CME, I suppose.
If I was a physician in Guatemala, I wouldn’t have ordered any tests either, and I would have only charged her a couple of chickens, or maybe a young goat. In America, unfortunately, we are required to overcharge, overtest, and overdocument in order to keep the hyenas at bay.

Comments

Anonymous
When did the definition of “required” change so significantly?
scalpel
My usage of that word is completely appropriate.
Diora
Scalpel, how is ordering tests that benefit you rather than the patient different from stealing?
Anonymous
Unless you’re “required” to by your insurer or your employer, it is not at all appropriate. “Choose” is appropriate.
scalpel
In the strict sense of the word, I’m not required to do anything. I don’t have to see patients at all, I can just sit in the nurse’s station and read the newspaper while the waiting room fills up. I could just cherry-pick the easy, well-groomed patients and leave the rest for the next shift. Of course, were I to do so, I wouldn’t have a job for very long.
The same sort of process applies to ordering tests. If I knew with 100% certainty before ordering a test that it would be negative, then it would be improper for me to order it. Of course it wouldn’t be “stealing,” because I don’t get any money for ordering tests, and the hospital doesn’t care if I order any tests or not.
But what if I was only 99.9% sure? And what if that 1/1,000 instance that I was wrong might result in a patient dying, or suffering an injury? Then the test is justified.
Am I required to order a test that I am 99.9% sure is unnecessary? Only if I want to keep practicing medicine. If I miss a diagnosis that results in death or injury once in 1000 times, then I am going to get sued a lot, and I won’t be very employable. So I am “required” to order tests that I personally feel are unnecessary, but that the attorneys and families think are mandatory. So I do.
I’d rather order 10,000 “unnecessary” CT scans than get sued one time.
Diora
But what if I was only 99.9% sure? And what if that 1/1,000 instance that I was wrong might result in a patient dying, or suffering an injury? Then the test is justified.

And you cannot explain the odds to the patient and have her sign a release if she refuses? Don’t you think your patient has a right to know that she is paying for 1/1000 chance that you find something?
Even if you find something, what is the likelyhood that finding something is going to make a difference? So the odds that your patient will actually benefit from the test may be even less than 1/1000. What about risks of the test?
It might be not stealing in a sense that you are not getting money, but you still order the tests mainly for your own benefit, and think it is perfectly fine to make her pay for it without informing her why the test is needed.
Anonymous
Diora,
You can do that, and most doctors do, with patients who have 1/2 a brain. Many still want the test that is 1/1000 likely to be positive. Especially if the government is paying, or if they have health insurance (that is why it costs so much).
Anonymous
Diora is right. When you order these unnecessary tests, why not be honest with your patients about it. It is a big difference when you are ordering for your own good health rather than the patient. Unless, you wnat to start personally paying for all these tests that you are ordering for self benefit. What a concept that would be.
You guys all talk about how bad American medicine is. the sad part is you have no clue the role you have played in creating that.
Anonymous
ONe reasonable thing to do would be to allow docs to forego extra testing and have the patient sign a waiver that they understand why the test was not done and that they cant sue on those grounds for med mal.
Of course, this has been tried many many times and the courts routinely throw out any kind of waiver like this.
In the eyes of the court, there is absolutely nothing ironclad or binding. Written contracts are worhtless and routinely thrown out by courts.
Lawyers and courts have made these arrangements virtually impossible, creating a haven of uncertainty at every turn. It is that uncertainty which makes our legal system insane and drives defensive medicine.
Anonymous
“Written contracts are worhtless and routinely thrown out by courts. “
This statement is, quite simply, patently incorrect. The commenter clearly doesn’t know what he/she is talking about.

Defensive medicine: Only in the USA

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