An nurse quite accurately the issue of practice variation in the ER:
This goes back to the free for all nature of medicine. One doctor practices one way and another, a different way. I see it in ER everyday with tests being ordered. There are the people who order a myriad of tests and those that don’t. There doesn’t seem to be a standard. I never have understood it. Why is there such a variance in practice? Looking at it from my perspective, it feels like so much of it is based on malpractice concerns. Can health care be reformed before malpractice law is reformed?
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- Reforming health care in the current economic climate
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How many times do we have to go over this. Now I might have some sympathy for doctor’s whiny, arrogant, entitled bleatings if there was some basis in fact, BUT there is no correlation between “defensive medicine” and not getting sued. Let me repeat that very loudly, THERE IS NO CORRELATION BETWEEN PRACTICING DEFENSIVE MEDICINE AND AVOIDING LAWSUITS. Because of this lack of correlation (and studies that I have seen might actually support the opposite conclusion), the idea that defensive medicine is anything other than bad medicine is bunk. In other words, defensive medicine does not serve the patient (I think every whiny doctor here probably agrees with that) and does not serve the doctor. Might as well be shaking a chicken around or lighting candles to avoid lawsuits for all the good it’s going to do you.
Elliott:
I agree with your sentiment and frustration; however, I would like to offer one word of advice. You seem to have this misperception of how doctors actually make decisions: all this talk of “DATA” and “EVIDENCE” is no match for the power of a plausible narrative based on personal anecdotes.
C’mon, “basis in fact”? You clearly don’t know what it’s like to be a practicng physician.
Elliott, I agree that practicing defensive medicine does not prevent lawsuits. Bad outcome, regardless of how it came about, results in a lawsuit. Defensive medicine allows us to win those frivolous lawsuits with bad outcome. It is very hard to win a lawsuit against a doctor who has ordered all the tests available and has consulted all the specialists.
Ding, ding! We have a winner!
Anon 11:39!
Elliott,
I direct you to this quote from my recent piece on defensive medicine:
“It is much easier to defend the fact that a doctor ordered a test, as opposed to not ordering the test at all.”
When a physician is in a courtroom being stared down by a plaintiff’s attorney, citing your studies won’t help the physician much, if at all. Ordering extra tests and consults will.
Thanks,
Kevin
Let me repeat that very loudly, THERE IS NO CORRELATION BETWEEN PRACTICING DEFENSIVE MEDICINE AND AVOIDING LAWSUITS.
Please show peer-reviewed studies/links that suuport this statement from reputable medical journals
Does that matter? The real question is whether there is a correlation between ordering more tests and winning the lawsuit so you don’t have verdicts against you.
Kevin,
What evidence is there to support your claim? In fact, given your arguments that there is too much litigation, and too much defensive medicine, it would seem that defensive medicine does no good at all.
Wait, don’t doctors have to decide what “reforming health care” means before they can decide any other steps?
You’re also assuming that the defensive tests involved carry zero risk of injury/harm to the patient. If you’re ordering a surgical biopsy even though you don’t actually suspect malignancy, there’s still risk involved. Can’t you just document that you’ve explained to the patient the tests aren’t needed but provided a means to them IF the patient wishes to proceed?
Other factors include the fact that a battery of tests (with associated costs and inconvenience) suggest a level of control over disease/disability by the physician that does not actually exist. That leads to malpractice suits when the bad outcomes happen. It also implies that every test is read and interpreted properly. More tests can easily lead to more ambiguity and risk not less so your assertion that it is much easier to defend is not based on anything more than a “plausible narrative based on personal anecdote.”
Elliott,
What you are saying about excessive testing is correct, and I agree with you. However, our opinions don’t matter in court.
Will a layperson jury have that insight about excessive testing? With the common perception that “more testing = better medicine”, I suspect not.
Kevin
Kevin, why do you “suspect” not? Just a guess, or based on a systematic review of cases?
How do you reach conclusions without any facts? Why do you believe everyone else is so ignorant?
Speaking of facts Elliot i am still waiting:
re: Let me repeat that very loudly, THERE IS NO CORRELATION BETWEEN PRACTICING DEFENSIVE MEDICINE AND AVOIDING LAWSUITS.
Please show peer-reviewed studies/links that suuport this statement from reputable medical journals
Shouldn’t the people like Kevin who are advocating policy changes based on the theory that defensive medicine DOES reduce the number of lawsuits won by plaintiffs or filed have the burden?
This nurse asked about why the variance between doctors’ practice.
Hey nurse, some physicians are just more confident in their decision making than others. Each patient looks different. Its a clinical decision.
So just get a hold of yourself and when you get a medical degree, THEN you can bitch.
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