Cover your ass, defensive medicine

Chris Rangel on how defensive medicine has changed the practice of medicine:

The practice of emergency medicine (among other high risk specialties) has become so regimented and infused with defensive medicine tactics that many ER docs are not even aware of how this has changed the way they think. It seemed as if this ER physician could not fathom the concept that we would send home a patient who could easily have just had a heart attack despite the fact that we were going to do absolutely nothing different for her then if she went home. Even though the possibility of litigation in this case was remote it was the constant and overall threat of litigation that has fundamentally changed the thinking of physicians and how they practice medicine.

This change in thinking has had significant consequences. Ever wonder why we spend so much on medical care? Part of the answer lies in this example. This ER doc was about to turn an $800 ER visit into a $4,000 hospital admission. Now imagine this happening all over the country in multiple variations and degrees of absurdity tens of thousands of times EVERY DAY.

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  • Dex

    Is there a study of which patients are more likely to litigate?

  • Anonymous

    No, but there is a study of which physicians are more likely to get sued. Turns out it’s the assholes. Who knew?

  • Anonymous

    Over just the last few years I have seen the ER’s in my state shift to rampant abuse of the commitment statues to commit patients with the most specious psych complaints without any evidence of even a cursory mental status exam.

  • Anonymous

    Actually there are studies on which patients are most likely to litigate. Uninsured patients are much more likely to litigate than insured patients. Patients injured in recreational activities are more likely to sue the doctor than patients injured on the job or who otherwise have someone else to sue. In my state, medicaid patients are much more likely to sue than privately insured patients. My carrier tells me that 80% of the suits filed here are by people on Medicaid or uninsured.

    The patient most likely to sue: an uninsured biker in the ER with a femor fracture acquired while riding his motorcycle under the influence.

  • Anonymous

    Patients injured on the job are more likely to have their medical bills covered due to workers comp, thus the need to sue for malpractice is lessened. That’s not surprising.

    But if you really want to reduce your chances of being sued, you should study which physicians are most likely to get sued.

  • Anonymous

    “But if you really want to reduce your chances of being sued, you should study which physicians are most likely to get sued.”

    Answer: Ones that will treat you in an emergency. Question is though do you want them to be around?

  • Anonymous

    Actually, the answer is the ones who fail to communicate with their patients.

    I have yet to figure out why physicians don’t look at their own behavior if they so badly want to risk their chances of being sued. There are so many studies out there that show you what you can do about it. Maybe it’s the fundamental arrogance that doesn’t allow you to believe you could improve.

  • Ann

    Has anyone given any thought to how hard defensive medicine is on the patient? Patients are more savvy about the care they need/receive. So a patient’s doc, who decides defensive medicine is a good idea, orders a test. The patient has been reading up on his/her symptoms and doesn’t understand why this test would be beneficial. So the patient asks. The doc is already in a “defensive” stance and interprets the patient’s question as a challenge to his/her competence. Instead of visiting with the patient about the whys of the test, the doc begins to send out messages to the patient that they need to find another doc. Yeah, that makes a lot of sense. Label the patient as non-compliant instead of engaging in a little communication, as was mentioned earlier.

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