CBS Evening News, defensive medicine, and me

I will be appearing on tonight’s CBS Evening News with Katie Couric during their piece on defensive medicine. They came to my clinic earlier this year for the interview. Let’s see how it turns out!

Correspondent Wyatt Andrews blogs about the story, and here’s a preview of tonight’s broadcast.

Update:
Read the story on the CBS News website.

And here’s the actual video:

Update 2:
Some blogosphere reaction. GruntDoc, TBTAM, and Dr. RW.

Comments are moderated before they are published. Please read the comment policy.

  • Maria, untelevised

    Ooh la la! Kevin is now a television star! (Up next: Your own reality show?)

  • Ervin L. Peacock Jr

    After looking at this report, I want to know something. What do we do in the case of a patient that was overmedicated? This is the case with my wife. Too much meds left my wife with stoke like symptoms on her left side and stuttering. We are in week 3 now. She’s somewhat better but she is still weak with her left leg. Could there be a lawsuit for this? We are considering it. Any comments, please email me at epeacock3@yahoo.com with the subject OVERMEDICATED.

    ELPJ

  • Anonymous

    Hi, found your website from the CBS program. As a nurse for over 20 years I can agree with you on defensive medicine.People now go on the web to these ” medical” websites and diagnose themselves and if the physician wont agree or order meds and tests, they will “doctor shop” to get what they want. Many doctors will give in to this pressure because it is so prevalant and widespread. It’s very hard to practice the art of medicine in these times. Good Luck

  • Anonymous

    ELPJ,

    You will have to prove that “overmedication” caused the lasting “stroke symptoms”. This is impossible to do (and also highly unlikely). I am sure that you can find some John Edwards wannabe that thinks that there is a case and he could even probably find some washed up dysfunctional MD that parades himself around as an expert witness whore.

    You can sue anyone for anything. It is your time and money

  • Joseph J. Neuschatz M.D.

    DEFENSIVE MEDICINE.

    For as long a medical liability jury is not a “jury of my peers,” the only way a physician can avoid the “doctor, why didn’t you order this test ?” question, is by ordering all possible tests under the sun.

    The following is from my Amazon webpage for my book “terrO.R.” (I sincerely hope this novel is fiction):

    RES IPSA LOQUITUR (or Why I Wrote This Book).

    In the era of “second medical opinion,” in an age when average magazine readers know more about face-lifts, nose jobs and breast reductions than family doctors do, 75 percent of people who have had anesthesia, don’t even remember the name of the anesthesiologist.

    Life in operating rooms is similar to life in submarines: no windows, no daylight, and always the same people around. The only “visitor,” is usually asleep. Life in operating rooms is also similar to life in airline cockpits: hours and hours of routine boredom, interrupted by moments of sheer terror. The induction of anesthesia is the take-off and its maintenance the flight. The emergence from anesthesia is the equivalent of a safe landing. The airport terminal ? Where else but the Recovery Room ?

    The anesthesiologist is the pilot who will fly you as safely as possible through somber surgical clouds.

    If a person dies suddenly in a hotel room, the initial diagnosis is “heart attack.”

    If a person dies suddenly in an operating room, the initial diagnosis is “anesthetic death.”

    American citizens are innocent until proven guilty. In murder cases, it is up to the police and to the prosecutor to prove that the murderer is the killer.

    AMERICAN PHYSICIANS ARE GUILTY UNTIL PROVEN INNOCENT.

    Why ? Because of the RES IPSA LOQUITUR doctrine (a Latin phrase which means: “the thing speaks for itself”). In other words: the patient was alive before the medical services and dead after them . Could the good doctor prove his or her innocence?

    But physicians are never invited to sit on a medical malpractice “jury of your peers” and, believe me, health care innocence is hard to prove in front of carefully selected non medical jurors. Raising “medical liability insurance” fees is simpler. Much simpler. The 2007 professional insurance for a Long Island neurosurgeon is $309,311 ! Would you encourage your child to become one ?

    BUT PHYSICIANS ARE NOT ALWAYS GUILTY AND “terrO.R.” IS HERE TO PROVE IT.

  • Anonymous

    Enjoyed the TV appearance — nice to see the face behind the site.

    Regarding defensive medicine: Just how much control do I as a patient have? If I decline a test, for example, what prevents the doctor from simply refusing to treat me further due to liability fears?

  • Joseph J. Neuschatz M.D.

    I disagree with this phrase from “Anonymous”:

    “You can sue anyone for anything. It is your time and money”

    Your time YES

    Your money: NO

    If an attorney accepts the case, we are faced with a “contingency fee” (33,33% of the legal loot, or more), but no money from the suer (just check the legal T.V. ads).

    Physicians should adopt a similar type payment:

    NO CURE = NO FEE

    CURE = 15% of patient’s worth.

    LIFE SAVED = 33,33% of everything the patient owns.

    Of course I am kidding ! It wouldn’t be ethical for any profession.

  • Joseph J. Neuschatz M.D.

    Anonymous:

    If you refuse a test, in a non-emergency case, a physician has the right to refuse to treat you.

    In a real emergency case, believe me, you will not refuse any test !

  • Donna

    I’ve been reading your blog for some time, so it was wonderful to see your face on television.

  • Dr. A

    Just saw the report on the CBS website. Well done. I hope you have more television opportunities. I agree – great to see the face and hear the voice behind the blog.

  • Sid Schwab

    The most astounding thing on the CBS piece was the cost of the CT scan (divided, as they do, between abdominal and pelvic); a total of over $7000! Adding the pelvic scan adds about 20 seconds, plus another five minutes of the radiologist’s time. That either part should be $3500 is outrageous and indefensible. I wonder if the ordering doc was aware of the cost.

  • Weschtester Orthopedist

    Two issues of equal importance emerge from this debate.

    As an academic surgeon in a large Level I trauma center I often wonder how this plays out in the minds of the residents we are charged with training. When we are over-zealous in ordering tests— it is typically not conveyed to the resident that it is for defensive purposes. Therefore, by observation, the residents are learning a skewed view of the “standard of care” for various complaints. Headache=CT, Backpain=MRI,Heartburn=EKG,enzymes…etc. Before long…as we start to retire, the residents that we have trained will be ordering tests, and assuming they are within the standard of care—not necessarily associating it with the practice of defensive medicine.

    The second issue is more timely. What happens to the risk environment in a situation where we recommend a test, the patient refuses and it turns out something was wrong. These are unchartered waters in the legal environment. How will that risk be shared? We will be held to a very high standard with regards to documenting why the test is important, what the potential consequences of not having the tests are, etc. The patient can always come back and say that when they refused the test they did not realize all the implications involved. How will the courts view this? Stay tuned.

  • Weschtester Orthopedist

    agree sid… I think Mcare reimburses <$400 in our area for CT and contrast. I know MRI will soon be sub-400 level.

  • Joseph J. Neuschatz M.D.

    The Westchester Orthopedist has a good question: “what happens if the patient refuses the test and it turns out something was wrong.” ?

    In my humble non-orthopedic opinion, the patients must sign a release proving that he/she understands the risks involved in refusing a test and assuming all responsability.

  • Anonymous

    The doctrine of res ipsa loquitor rarely, if ever, applies in a med mal case. Yet another example of physicians acting to mitigate a risk they lack any understanding of.

  • Joseph J. Neuschatz M.D.

    Re “RES IPSA LOQUITUR.”
    1)I forgot to emphasize a point: the family of a “cardiac arrest on the O.R. table” patient is allowed to sue the surgical team, even if they refuse, the only hope for a final diagnosis, AN AUTOPSY (for religious or other reasons).

    2)Anonymous: I hope you are kidding !

  • Weschtester Orthopedist

    Joseph,
    I do not think it will be that simple. The burden of the documentation necessary will be onerous. We will need to document that the patient clearly understood why the test was ordered. What the implications of their refusal are…and so on and so on. The patient, via the attorney, will argue that any reasonably prudent person would never refuse a test that could potentially find a fatal illness or disease state that results in significant morbidity. I try to talk patients out of routine MRIs on a daily basis. It takes 5-10 minutes to discuss why they dont need the test(and they are not happy after that) instead of 30 seconds ordering the test. Lots of variables to consider…even more potential pitfalls.

  • Anonymous

    My favorite part of the interview was that the woman interviewed was a doctor’s daughter. I am surprised she did not get the ultrasound AND the CT! As for the bill, of course NOBODY will pay that amount, especially not the government or an insurance company, much less an uninsured patient. Not to mention that the radiologist’s and ER physician’s bills are no doubt yet to come.

    Setting prices at these ridiculous levels only inflames the situation and makes for bad debt if the patient is uninsured. My babysitter, uninsured, had EXACTLY the same malady, spent over 16 hours in the ER, and had a similarly large bill. Why did she go to the ER? Because her primary care physician told her to. And I loved the part of the TV segment where suggested questions to the ER doctor are proffered. Does anyone really think a patient is going to question the ER doctor, if the are in fact even seeing an MD rather than a midlevel on their ER visit? Does anyone really think an ER doctor is interested in discussing such matters? In my opinion my babysitter should have had a CBC and lytes drawn in the office and an outpatient abdominal US ordered. Due to her prolonged ER ordeal she also missed a day of work, and I had to curtail my clinic to take care of children. S

    So what could I tell her about her exorbitant and patently unreasonable bill? Pay the doctors first, their bill is MUCH less and they did the work, then try to reach a compromise amount with the hospital as they will be happy to get something rather than nothing. Wrong! Of course she ended up being turned over to a debt collection agency, but since she has no assets or credit anyway, the hospital will get NOTHING until they go to Uncle Sam for a handout for their “uncollectable” debt. Are you taxpayers angry yet? Everybody loses in this scenario, and a patient who only followed “doctor’s orders” and is willing to make payments on a reasonable cost basis is overwhelmed and demeaned.

  • Anonymous

    You guys believe there are literally millions of suits filed every year, so surely you can point me to a significant number of RIL cases?

    I hopw you’re not charging for that legal advice.

  • geena

    That was a great piece!! So nice to see the blogger behind the blog :-)

  • M.

    Westchester Orthopedist: “It takes 5-10 minutes to discuss why they don’t need the test(and they are not happy after that) instead of 30 seconds ordering the test. Lots of variables to consider…even more potential pitfalls.”

    I thought the idea behind this was that eventually, after some possible scheduling difficulties, that patients would be better consumers and understand the reasoning behind such decisions? I’m still not sure that would work, as people usually do expect certain things (as they’ve always had the classic hallmarks of the visit) and there is definitely a certain backlash against the, “my doctor didn’t do/give me anything” upsets.

    I brought up the informed refusal in the annual physical discussion, seeing it come up again, I’m wondering how a patient would respond to having to sign such documents (more often that they usually would); both in terms of their perception of the care provided and what action they choose to take (I’m imagining some patients feeling bullied & the old age ‘my doctor only cares about himself’ comments would come up, possibly hurting the relationship). Aren’t there a couple of legal loopholes to informed refusal, as well? (well if not, I’m sure there could be…)

    Congratulations, Kevin!

  • Anonymous

    “I’m wondering how a patient would respond to having to sign such documents”

    You have to give them the opportunity before you’ll ever get a useful answer to that question.

    I actually did propose this to my doctor and to his clinic’s risk management office. No dice. Continue with treatment exactly as ordered or go elsewhere.

    I don’t see how you can possibly reduce the expenses of defensive medicine without the medical side and the consumer side both being willing to accept some risk. Sounds like that will require a lot of education on all fronts.

  • Joseph J. Neuschatz M.D.

    Weschtester Orthopedist,

    You know what ? I think you are right. Ambulance chasers are very, very clever, very, very sneaky. Even among us here seems to be one with hidden identity and, claiming to be “a nurse for over 20 years.”
    Joe

    P.S.: If somebody is interested:

    http://www.americanauthorsassociation.com/Book%20Review-TerrO.R.%20-%20Neuschatz.htm

  • Joseph J. Neuschatz M.D.

    Contingency fees hungry attorney claim that professional peers are already allowed in jury cases– they are called expert witnesses.

    Expert witnesses are exactly that: WITNESSES. They don”t take part in the legal decision. And the carefully selected juries don’t always understand the pathological facts.

    Do you want to be rejected from jury duty in a medical liability case ? Just tell them your spouse or your best friend is a physician. It happened to my wife.

  • Joseph J. Neuschatz M.D.

    The Non-Hypocritic Oath

    I swear:
    To obey the law and practice medicine to the best of my knowledge and according to my local judges, medical malpractice lawyers, jury decisions, mandatory second opinions, liability insurance companies and HMO limitations.
    If abortions remain legal, I will or I will not produce them, depending on my own personal beliefs, on the number of abortion clinics burned in my immediate vicinity, and on the number of anti-abortion people picketing the local hospitals.
    I will give no deadly medicine to anyone if asked, nor suggest any such counsel. Unless, of course, a euthanasia law is finally passed and I will then make such desperate decisions case by case.
    Whatever in connection with my professional practice, or not in connection with it, I see or hear, in the life of men or women which ought not to be spoken of here or abroad, I will not divulge, as reckoning that all such should be kept secret.
    Unless of course, their charts are subpoenaed by medical liability attorneys, requested by Medicare or Medicaid, checked by the hospital peer review committees or investigated by the department of Health.
    While I continue to keep this Oath unviolated, may it be granted to me to enjoy life and the practice of the Art of Defensive Medicine.

  • Mudpuppyfarms

    Dear Dr. Neuschatz, Not a lawyer,just a nurse.I stand behind what I stated earlier. Patients and families always ask us if what you order is correct and is everything being done. We assure them, that- yes, your doctor knows what he’s doing (not in those words- but you get the idea). Well meaning family and friends suggest other treatments ” the doctor may not have heard about________ “. They don’t want to call or talk to you about it, but ask us to. That’s when you get the calls at your office from us(no- not to annoy you) but to inform you what’s going on with your patient. I do as a patient advocate need to tell you this, even if some of the things they say or ask for will not help, that is your decision to make. But again if they aren’t satisified they will go to someone else until they get what they want.
    I have seen many an adverse reaction to meds because the patient “forgot” to tell their primary physician, that they were going to 5 other specialists, and they were taking over 20 different meds and OTC pills. I just think between the drug company ads, the insurance companies and the ” medical ” websites, patients are too often second guessing their doctors. They forget that there is alot more to being a doctor than reading a book and as a nurse, I wish patients would have more confidence in their physicians skills.

  • beajerry

    Nice work Kevin!
    I enjoyed the piece.

    But do you always take patients’ blood pressures yourself or does your nurse to it?
    ;)

  • Joseph J. Neuschatz M.D.

    Dear Mudpuppysfarm,

    SORRY !!!! After I wrote what I wrote, I realized my mistake: there are more than one “Anonymous” here and, it is confusing. It should not be allowed. I wrote to Dr. Kevin on this subject. Everybody should have a private screen name.

    SORRY AGAIN !

  • Anonymous

    Medical Imaging costs are completely out of control. Medico-legal implications aside, the fact is medicine is no longer a profession but a lucrative business -at least for some. The parallel with the Military Industrial Complex is uncanny. Medical equipment manufacturers roll out almost on a daily basis newer, better, and obviously more costly gadgets that dazzle doctors and patients. As industry would have us believe, we are just one more multi-million dollar machine away from perfect health and happiness. The deployment of this equipment in the community is usually a revenue-generating enterprise, and has nothing to do with the health care needs of the public at large.
    The public health implications of medical radiation have barely been
    touched. Every patient who receives an unnecessary CT scan is another data point in a massive, uncontrolled and unsupervised experiment in the effects of radiation on a large human population (in this case the United States). Responsible governmental bodies look the other way, perhaps for lack of adequate funding, authority or interest.
    After all, the prevailing philosophy is that government is the problem, private equals good, and corporate profits rule.

  • Aggravated DocSurg

    Just wanted to say “nice job, Kevin!”

  • Anonymous

    “I just think between the drug company ads, the insurance companies and the ” medical ” websites, patients are too often second guessing their doctors. They forget that there is alot more to being a doctor than reading a book and as a nurse, I wish patients would have more confidence in their physicians skills.”
    This is correct in part, but if we know that doctors practice defensive medicine i.e. order tests that we don’t really need, why should we be nice and quiet and comply? How can I not question my doctor if he routinely orders a non-recommended urinalysis on a physical exam (AGAINST recommendation from USPSTF, risks likely to outweight benefits). Why shouldn’t I refuse the test that is more likely to harm me (false positives, overdiagnosis) than help me? What about an ObGyn who routinely orders ultrasounds (every year) I have to pay her out of my deductible for no symptoms? Pray tell me how can I unquestioningly trust my doctors when they admit in ordering tests that I don’t need? I know that most people want every test in the book, but I am not one of them.

    What about a doctor that wanted to prescribe statins for my LDL about 4 points above guidelines for my risk factors (if you go by numbers, not by absolute risk) even though my 10-year absolute risk of heart desease is under 1% (which doctor forgot to mention because either he doesn’t understand the difference between absolute risk and relative risk himself or he thought I don’t understand it, and this is in spite of my math degree)? Don’t you think I have a right to decide if .3 percentage point of risk reduction worth going on medication? I am a woman by the way, and the evidence for primary prevention in women is ever so overwhelming… NOT. Are you denying that some doctors overprescribe?

    On the other hand, in some cases the doctors may indeed not know something and not order a test when it is indicated, especially if you have a rare condition that only affect a very small percentage of people. I happen to have POF, and starting at the age of 32, I’ve had 2- and 3- months delays in periods. At the time I wasn’t doing any research on my own, so I trusted my doctor. When my doctor ignored my complaints (“How are your periods”, “I’ve had some delays, 2- and 3- months”, “when was your last one”, “two weeks ago”, “OK”) or when I came with 4- months delay checked my thyroid, did a pregnancy test and sent me home with a prescription for Provera, I thought it was fine. I switched doctors at some point, but when the next doctor assured me that I cannot possibly be in menopause and that my hot flashes were all in my head, I believed him. It is only when I was 38 and the Provera failed to work, that he ordered a hormone test. Surprise, surprise – estradiol of 20, FSH of 70. It didn’t get there overnight, don’t you think? Had I done some reading on my own, maybe I would’ve asked to check my hormones sooner. It is not like this is expensive – it’s a simple blood test. Maybe it wouldn’t have changed anything, but maybe it would’ve helped my bones. I certainly regret not insisting on hormone test. I don’t blame my doctors, at least not anymore (although I was bitter for a while) – this is a rare condition and it is often undiagnosed for years, but I do blame myself for not being assertive and not insisting on hormone test. I am not yet 50 and I already have osteopenia. Maybe had I insisted on a hormone test at 33 or 34 or 35, it wouldn’t have made a difference, but maybe it would’ve. Maybe at the age of 33 I was still ovulating occasionally and could’ve rushed to have a baby (I am single which is why I hadn’t had a child sooner). Oh maybe it was already too late. I would never know, would I? Not to mention all the sleepless nights and all the symptoms that are a lot more severe when you experience them in your 30s and not in your 50s.

    I realize that some people seem like pain in the .., insisting on every test they see on TV or on antibiotics for common cold. But simply following your doctors suggestions unquestioningly is not always the right answer.

  • Anonymous

    Thanks, I didn’t have a name until today and saw the comment posted after mine. I do give you all the credit for staying in the profession. I have some friends that are leaving NY because of the malpractice insurance, and one who will not be doing obstretics as part of her practice, just too risky and expensive and she’s tired of the ” Can I have the baby on Nov. 5th in the morning” thing. I don’t know what people will do when we no longer have physicians, because of the too many hands interfering with their decisions on how to treat a patient. I have helped out in case management and what a joke- call an insurance company lay person to request a CXR that’s been ordered for a CHF or pneumonia patient and have to answer a dozen questions before an approval. I felt like yelling. ” BECAUSE THE DOCTOR ORDERED IT”, big waste of my time when I could be actually taking care of the patient. Well hang in there. We need you. mudpuppyfarms- JP

  • Sundar

    Questions for Dr. Kevin:

    1. Have you been ever sued in your life time? How many times?
    2. Did any of those above go to trial? how many settled? how many dismissed? how many you lost? how many you won?

    Till you answer all the above, you are no different another Joe doctor whining.

    I am a radiologist for over 30 yrs. we are the ‘guys behind the tree’ which other physicians actively encourage their patients to sue for their errors of omission and commission. I got trained as a physician first before became a radiologist. The original art of ‘ listen,look, feel and think’ have gone way of the dodo bird. Who is responsible? Multiple sources beside tort/medico legal. But the FIRST culprit is ‘US’ Look in the mirror. Medical Education(Amer Med colleges, AMA, Amer Hosp association – the usual suspects) in USA needs another Fleschner study and over haul. Next tort reform, health education in elemenatary, middle and high schools. Alas, there is no money in it! So nothing is going to happen. Business as usual.

  • Michael Rack, MD

    ” But the FIRST culprit is ‘US’ Look in the mirror. Medical Education(Amer Med colleges, AMA, Amer Hosp association – the usual suspects)”

    I agree that the AMA and other elements of organized medicine are the problem. However, don’t call them ‘US’- they may represent you but not me. Resigning my AMA membership is the smartest thing I ever did (after resigning my APA membership).

  • Joseph J. Neuschatz M.D.

    As a reply to the obstetrical comments above, may I emphasize that here in Long Island NY, the 2007 medical liability insurance for an OB/GYN is over $200,000 while Insurance Companies are paying, or trying to reimburse less.

    Many such doctors are leaving the State. Others are just abandoning the OB part of the practice.

    They are repeatedly being sued, after the birth of an imperfect child, even if the mother is a smoker, an alcoholic, a drug user, or all three. The “privacy” of personal habits is respected in our courts of law.

  • Anonymous

    Actually, every one of those factors can and would be brought out by the defense counsel in a lawsuit. I don’t know where you got the impression they would not, but it’s completely false.

    Probably the same person who made you think res ipsa loquitor was used in malpractice suits.

  • Joseph J. Neuschatz M.D.

    Thank you for making me laugh Anonymous Esq. Even if what you say it’s true, do you want me to believe that the suing attorney will allow his client to acknowledge smoking and drinking alcohol during pregnancy or using drugs ?

    By the way: how many honest medical malpractice lawyers does it take to change a light bulb ?

    Answer: BOTH OF THEM.

  • Anonymous

    “Even if what you say it’s true, do you want me to believe that the suing attorney will allow his client to acknowledge smoking and drinking alcohol during pregnancy or using drugs ?”

    It’s not his choice. It’s the rules of evidence. Do you really think a smoker can hide smoking from every potential witness for the nine months leading up to pregnancy and then the time until trial? Do you think drugs won’t show up in some of the numerous blood tests? That no one observed her drinking? And that this person who is stupid enough to do these things during pregnancy is going to hold up on her story through depositions and cross exam?

    Be serious.

  • Mudpuppyfarms

    Dear Dr. N, O.K, I think I’ve come to a way to stop the all malpractice suits.
    When every physician stops practicing medicine at the risk of a friviolous lawsuit, then nurses will no longer be able to care for patients ( we work under the direct instruction and supervision of the doctor).
    These same lawyers will now have a MORAL and ETHICAL responsibility to care for very patients that they sued for.
    Yes, since they already know more about the care and treatment of patients than the doctor does, I’m sure they wouldn’t mind.
    Bedpan, anyone??????? mudpuppyfarms JP

  • Joseph J. Neuschatz M.D.

    Dear Anonymous Esq.

    Found on the Internet:

    Fortunately, the law recognizes that plaintiffs face certain difficulties in proving medical negligence, due in no small part to the fact that they are often not conscious when the negligence occurs. If a patient is injured as the result of a medical procedure does not know exactly what caused his or her injury, but it is the type of injury that would not have occurred without negligence on the part of his or her health care provider(s), he or she may invoke a legal doctrine known as “res ipsa loquitur.” Translated, this Latin phrase means “the thing speaks for itself,” and implies that the plaintiff need only show that a particular result occurred and would not have occurred but for someone’s negligence.

    This is why

    http://www.americanauthorsassociation.com/Book%20Review-TerrO.R.%20-%20Neuschatz.htm

    is so probable and so timely.

    JJN

  • Anonymous

    7K for a scan and a read? WTF Radiologist’s better enjoy this gravy train because it is not going to last. Once malpractice issues are worked out, these scans can be read overseas at a fraction of the price. Nighthawks is just the beginning.

  • Anonymous

    I realize you’ve got a book to shill, but again, can you cite me to even 5 malpractice cases where the doctrine of RIL was successfully applied?

  • Joseph J. Neuschatz M.D.

    Great idea Mudpuppyfarms !

    Here is another one: statistically speaking, the unsafest place in America is a hospital bed. More people die in a hospital bed than in any other location: restaurant, shopping mall or ice-cream parlor.

    I had my bed for 40 years already and, so far, nobody dared dying in it. Therefore, if American get sick, let them stay home in the safety of their beds.

    BEST,

    Dr. N

    P.S. I would love to have your opinion on my above mentioned novel.

  • Joseph J. Neuschatz M.D.

    My dear Anonymous Esq.

    You know pretty well that physicians (like all other professionals), discuss victories and try to forget defeats.

    Where would I find you 5 RIL cases ?

    All I know is that the undersigned had one such a law suit -which made me write “terrO.R.” (fiction ?)- and for me, Res Ipsa not only represents 100% of my legal experience but also made me realize how easy it is for ambulance chassers to make money on physicians backs.

    JJN

  • Mudpuppyfarms

    Dear Dr. N, I will gladly read today and post. And yes, you are correct about the hospital beds, as the old saying goes- If you want to stay well, stay out of the hospital.
    If more people would go for regular check-up’s with their physicians, things would be caught before a hospitalization was needed. Again,the ER is overused in place of seeing their doctors, but many of the people are uninsured for whatever reason.
    We have a local clinic here, that people are encouraged to use and it’s based on a sliding scale fee, no one pays more than 30.00 a visit, but it’s staffed by a NP ( who I know and is quite competent)and nurses. But alot of the people prefer to see a real doctor, even if it’s in the ER.
    By the way after further consideration of my last post, I didn’t think it through throughly.
    It came to mind that after all the lawyers are busy taking care of these patients, who is going to sue them for malpractice? Maybe they can pay back the money they won (notice not earn) into a program that decreases insurance for physicians and sign an agreement- no more friviolous lawsuits, and let doctors and nurses get back to work, helping and healing patients just as we should. mudpuppyfarms JP

  • Mudpuppyfarms

    Dear Dr. N,
    Wow a 5 star rating, and great review- I’m hooked, I love a good murder, mystery, thiller. I used to read Stephen King as a teen, then onto Robin Cook. The book should be here in a few days and I will post.
    As a side note- four years ago had an “elective procedure” although both myself and my PS agreed in was “medically necessary”, trust me on this one.
    Well when I woke up, the anesthesiologist was present and told me he had a little trouble intubating me, and asked if I snored, etc. Told me should talk to my doctor, if my hubby thought it was bad or if holding my breath.
    Sure enough, sleep study showed mod-severe apnea. At 37, female and not overweight, now I have a Darth Vadar mask, and I get the best sleep of my life. Now I think without his observation, I don’t know how long this would have went on for or die in my sleep from it.
    So I was thinking, that since you have a talent for writing and if you decide to change your genre to non-fiction, may I suggest a title ” Yes, a boob job can save your life” or ” Real stories from the intubated unconscious”
    Have a great week- mudpuppyfarms- JP

  • Joseph J. Neuschatz M.D.

    Dear Mudpuppyfarms,

    Your ideas are great ! Why should I write them down for you ? You have literary talent. DO IT !

    I was thinking to quit writing and become an executioner. After all, in the post-electric chair era, who knows better than an anesthesiologist how to administer intravenous drugs ?

    But the lawyers scare me. What happens if “the patient” survives ?
    Will I have to buy “Executioner Malpractice Insurance”….?
    (If you read my book, you’ll find this idea in it -SORRY !)

    Dr. N

  • Anonymous

    Cleveland Clinic posts fees. You’re seeing more and more of this, as you see more patients with Health Savings Accounts.

    Abdominal CT with contrast is $1910 at the Cleveland Clinic.

    http://cms.clevelandclinic.org/documents/CCMain_HB197_2007.pdf

    That “rack rate” of seven grand is going to get cut back quite a bit.

    Kevin, if you still have any connection with the reporters who did the news segment, you may want to point them in that direction. The grossly inflated “rack rate” at most hospitals, and how the uninsured can get stuck actually paying that.

  • Anonymous

    Kevin,

    I wish I would have seen this 1 month ago.

    I have had what I thought was an abdominal muscle strain that just kept getting re-aggrevated. I finally went to a doctor at the Cleveland Clinic and he diagnosed me with an Inguinal Hernia. He was wrong. He sent me to the surgeon. The surgeon could not find the Hernia and casually sent me for a CT Scan. No discussion about costs or what this test was about. I did not have the background or frame of mind to ask about costs. I figured it could not be much because I am just getting diagnosed for simply either a aggrevated muscle or a hernia. Medical 101. Nothing else was discussed. The CT scan showed that I did not have an inguinal hernia. I do have an aggrevated muscle.

    My bill came the other day and they charged me $3500 for 2 CT scans. ????? I am at wits end.

    The Clinic is telling me I should have asked for the costs. I am telling them they should have let me know this is an expensive procedure and that it is not really necessary. Am I supposed to ask for the costs and how many pictures they are going to take? I am just an ignorant patient who goes to see a doctor about once every 5 years. The Cleveland Clinic posts a patients bill of rights but I say it is lip service. I did not experience world class treatment nor customer service.

    What can I do to fight this?

  • Anonymous

    To the anonymous poster above regarding the Cleveland Clinic posting their CT Scan price: Where? They do not post them in the office or lobby where a patient may actually be exposed to it. The doctors nor staff do not make any attempt to make the cost known. Even if it was posted, they do not tell you how many pictures they are going to take.

    I was just there in May of 2008.