If this isn’t defensive medicine . . .

January 2, 2008

. . . I don’t know what is. And I strongly suspect that many other cardiologists think the same way:

Another told me that it was his policy to “cath” almost anyone who came to the E.R. complaining of chest pains. In his opinion, the risks posed by routine angiograms were much less than that of a missed heart attack.

KevinMD.com on Facebook

Follow on Twitter Subscribe

Tagged as: heart

{ 5 comments }

1 alexa-blue January 2, 2008 at 5:24 pm: Wow. Now that’s moral hazard.

(The rest of the article is pretty good, too)
2 Anonymous January 3, 2008 at 9:00 am: So does it work? Probably not. Once again doctors are not doing their jobs. An interesting take on this very issue can be found here:

http://www.lifeclinic.com/healthnews/article_view.asp?story=508121

If physicians would apply some rigor to their decision making, instead of hiding behind “the lawyers made us do it”, their lives and their patients’ care would be much improved.
3 Gasman January 3, 2008 at 11:42 am: It is however human nature to attempt to respond to incentives. If the incentive driver is the potential lawsuit then behaviors will be created to attempt to reduce the risk of lawsuit. Creating incentives always leads to altering behaviors, but not always in the manner desired.
The cited text in Kevin’s post shows that the doc cannot logically and emotionally separate his risk from the patient’s risk.
The only way for the doc to do as anonymous wishes, to decide only on the patient’s behalf, is to eliminate incentives that cloud thinking about who’s risk is to be considered.
There is no human capable of completely disregarding their own interests. The best we can do is to avoid incentives system that produce results contrary to what we want.
4 Matthew January 3, 2008 at 12:11 pm: There is no defensive medicine. A lawyer told me that once, and they’re smarter and more honest than doctors, so it must be true.
5 Anonymous January 3, 2008 at 2:27 pm: “If the incentive driver is the potential lawsuit then behaviors will be created to attempt to reduce the risk of lawsuit. Creating incentives always leads to altering behaviors, but not always in the manner desired.”

Yet it’s clear that defensive medicine (an undefinable thing if there ever was one) does not reduce the risk of liability if the claims of more suits are to be believed.

It’s also clear, from numerous studies done by physicians, that what does reduce one’s risk of a lawsuit is treating your patients with more compassion and spending more time with them – even 3 minutes.

So who is to blame if physicians fail to alter their behavior in a manner that would allow them to achieve what they desire? Particularly when they know, or should know, that what they are currently doing is NOT working?