Anyone who reads this blog knows what I think about defensive medicine, and how I feel it is one of the leading factors in rising health care costs today.
Two articles in the news highlight this. The first one suggests that defensive medicine practices are spreading to paramedics:
“I think that for most physicians now, it’s the fear of being sued for missing a diagnosis,” said Scott Maizel, a surgeon at the Sandra and Malcolm Berman Comprehensive Breast Care Center at the Greater Baltimore Medical Center and former president of the Maryland Chapter of the College of Surgeons. “Physicians are now performing more tests, (writing) more referrals and frequently require more visits back to the doctor to make sure nothing was missed.”Besides physicians, many prehospital professionals are also taking precautions.
Ocean City Fire/EMS Capt. Charles Barton said while liability for prehospital care is lower for EMTs and paramedics, there is still concern.
“I think most people are concerned about liability issues,” he said. “(However), risks can be managed and liability can be reduced.”
The second asks some questions that policy wonks and lawyers seem to ignore:
Twenty percent of the time or less, more in-depth testing and treatment is required.(These are called”zebras” – which are uncommon.) “Defensive medicine” is when those extra tests, procedures and treatments are done on the common illnesses(zebra tests on horses). Why are they done? Primarily to avoid being found “negligent in a malpractice court.”What is the cost of these additional tests?Hence, the real costs of malpractice avoidance? How many lawsuits are initiated by people(or their lawyers) seeking “easy money”? Often, these are “settled” just to avoid the high costs of court procedures plus the emotional and time costs, but no malpractice has been done! What are the “costs” of these “frivolous lawsuits?” How much time and energy have you spent trying to “fight” a traffic ticket? What were the costs?
But just the experience of being “sued for malpractice” will push the health-care provider to practice more defensive medicine. At what cost to the health-care system? Surely more than 2 percent.
Related posts:
- Defensive medicine wastes money and hurts patients
- Why do doctors practice defensive medicine?
- Defensive medicine op-ed reaction
- Some lawyers say defensive medicine isn’t real, but this doctor shows us otherwise
- Defensive medicine
- Should severe birth injuries be pulled out of the court system, and can defensive medicine be good?
- Lawyer: "I want my doctor to use defensive medicine"
{ 16 comments }
“Spreading to paramedics?”
Doc, it’s been prevalent in EMS for years. Virtually every EMS system in this country is designed specifically to serve less than 1% of its run volume – cardiac arrest patients.
We continue to spinally immobilize (now there’s a misnomer!) trauma patients, despite the evidence that clinical exam criteria can safely clear these patients and other evidence that questions whether pre-hospital spinal immobilization is even beneficial.
We fly people on helicopters based on nothing more than mechanism of injury, despite the mounting number of fatal crashes and the fact that 95% of those patients flown to the ED were discharged home directly from the ED. That’s right – we flew them on a $10,000 flight, and they weren’t even sick enough to be admitted.
Prehospital care is a bastion of defensive medicine. Has been for some time.
Nothing like guesses masquerading as fact.
Hear, hear to your post, and to ambulance driver’s comment. I keep reading that statistically, it’s been “proven” that defensive medicine doesn’t exist. Anyone in the profession knows otherwise, big-time. I have cynically concluded the American Bar Assn. don’t want the true costs of defensive medicine known, since it would certainly result in tort reform. What they want, they get.
The ABA has never taken such a position. Nor has any organization of attorneys.
The guesses are those claiming “defensive medicine”. It’s an undefinable concept, and thus essentially useless to basex policy on.
Which is why Kevin uses statements that are essentially meaningless like “leading factors”.
I think “defensive medicine” is “blamed” on fear of malpractice, when it is really Doctor’s not trusting their own expertise and experience. It is a cop out.
Why does it take 12 years of medical education to just order every single test imaginable? You may not realize it, but when you order 12 different tests for us, (that you convince us we need), and they ALL come back negative, we lose trust in you, and think you’re an idiot.
That’s fine by me. You can’t sue me for being an idiot, but you can sue me for not ordering 800 tests. Let’s call it even.
touche’ 8:26, and might I add, good form.
I wouldn’t want to sue you for being an idiot. I also have never wanted to sue any of you for malpractice either. But your attitude sucks! You should care if your patients think you’re an idiot. Like it or not, without us, you aren’t in business.
Word of mouth spreads like wildfires. You make enough of us lose respect for you, and it can end up hurting you!
Besides, what is your plan when the insurance companies start screaming ins. fraud?
To be serious for a moment: because what we’re talking about is not cases where tests are indefensible, we are talking about cases where you’re MOSTLY sure but a test could be justified. Yes, it looks just like appendicitis. But 1% of the time it’s not. From an overall cost-benefit perspective, getting a CT scan to catch that rarity is probably not worth it to the health care system. From a being-on-the-stand when the lawyer puts his expert on that says he would have gotten a CT scan perspective, it’s priceless.
The beauty of the scheme the lawyers have set up is that when a few (usually bottom of the barrel) physicians start doing this, it exerts a pressure effect on the others – it’s very easy to call someone negligent for not ordering a test when you can point out other people who would have ordered the test. Then the herds move over to ordering the test to cover their asses, and it becomes malpractice to not order the test, even if it’s stupid. Welcome to American medicine.
Of course all this laying of blame on others ignores the obvious fact that physicians have no idea whether “defensive medicine” works or not. Anon 11:07 unwittingly admits it.
If physicians want the standard of care to be X in the situation he/she presents, they need only promulgate a national standard. However, whenever that is suggested, they all run from it with various excuses.
If you don’t like “bottom of the barrel” physicians, tell the public who they are and they’ll quickly be out of business. Or better yet, educate them yourselves – they’re reflecting on YOUR profession.
If you want to end defensive medicine, create national standards of care. Although I think you’ll find when you do, that nothing much will change because “defensive medicine” has other motives. As it stands, though, I doubt it changes, because physicians really aren’t inclined to do much about it but blame everyone but themselves.
CJD
CJD,
As you know, creation of national standards of care is something that I have been advocating as a possible solution for awhile:
http://www.kevinmd.com/blog/2007/04/defensive-medicine.html
Thanks,
Kevin
Kevin,
Why do you believe it’s not happening?
CJD
“Why do you believe it’s not happening?”
To a certain extent it is happening. Look at guidelines from any national organization. They are easily available. Google your disease de jour and see what comes up. The bigger issue however is that in many disease states/processes their is no set right answer (ie there are many way’s to skin a cat). In other processes there is controversy as to what is the right answer to treatment. Neither issue exactly facilitates towards easy national standardization now does it CJD? It is easy to talk about “national standards” in the hypothetical, it is much different to institute them. Human biology is a little more complicated than legal briefs and frankly we don’t know all the answers/science.
That’s exactly what I expected someone to say. Exhibit “A” on why we’ll never have those standards.
But two questions – if that’s the case, that we’re all so different that you can’t have an ordinary standard of care for certain presentations, then how can you complain when the plaintiff’s expert disagrees with your own expert?
Second, while there are undoubtedly some issues which arise that defy uniform standards, surely the vast majority are not that way. If reducing litigation is the key, why not find the commonalities in most claims and promulgate a standard for those?
As for writing legal briefs, I invite you to try if you think it will be so easy. I’ve got an appeal I’d love to not have to delve into on some rather complex issues. What will you charge for such an easy thing?
National standards will kill innovation. They represent malpractice by their cookbook approach. They will be written by inexperienced, paper shuffling academics, catering to the defensive medicine of lawyer oppressors of the clinician. They always take massive amounts of time to fulfill, with no proven benefit to individual patients.
In 90% of cases, they are used as a spear against the doctor, and not as a shield.
Usually, they are garbage science. They change every 2 or 3 years. So we know they are wrong, per se. Defendant doctors should review with their personal attorney (not the insurance defense lawyer) the possible filing of cross claims against the relevant guideline makers as individuals, their employers, and any professional association that peddled anti-scientific garbage. To deter.
Anonymous lawyer, you land pirates drive health care costs through the roof, then blame doctors for complying with case law.
Why not review Rule of Conduct 8.4 (c), the scope of the Rules in their preamble? Then tell us your real name and Bar number.
Anonymous lawyer, pass lawyer control statutes. Exclude anyone who passed 1L from all benches, all legislative seats, and all policy positions in the Executive branch.
That would cut health care costs in half, at a minimum, with improved health stats.
All social problems, all social pathologies, all policy dysfunctions have a rent seeking, land pirate, lawyer making money as a cause.
If people don’t like their health care costs double what they should be, thank the land pirates.
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