I thought the sudden onset of a severe headache (especially with a stiff neck) should result in a CT (followed by a LP if the CT is negative)
Detecting a anyerusm before it ruptures is always prefentiall.
True the patient will need a coiling procedure (or similar) and there is clearly great risk with any attempt to repair the anyerusm,

Seems like the classic defensive medicine issue. Lots of headaches in the ER. Vey few SAH. However, if I had a “the worst headache of my life” (if not the result too much vino) I would want the correct workup.

This argument will go round and round and no one is certainly going to convince you to see things from the other’s point of view. It is much easier to criticize someone when you’ve never been in his shoes.

Wrong, totally. First, even when not doing the test themselves, doctors arguably do have an indirect interest in being a provider to hospitals of patients needing procedures. Referrals are commodities and those who provide them are of value. Hospitals create cultures and expectations of high volumes of testing–that was the point of Gawande’s article.

Second, doctors have no motivation NOT to order tests. It’s costless to them. And they have–even with no medmal liability– at least a reputational interest in getting the right answer. To the degree a test may marginally help diagnosis, the doctor will, therefore, order it. To take yr example, the emergency physician will order a CT if it might help out; when his patient gets cancer 20 years down the road, that doctor won’t be around, so who cares?

How amusing. Seeing how many doctors who have no vested financial interest in ordering more tests but still do, your statement is completely one-sided. Of course, some doctors do tests/procedures because they’ll get paid for doing them, but the ER doc doesn’t get paid more for ordering an extra CT scan. What’s his motivation?

How does an ER physician benefit economically from ordering a CT of the head on people who come in complaining of a headache?

Are there bad physicians out there? Absolutely. There are also bad lawyers. There are also good physicians who make up the majority who are just trying to stay out of trouble.

My guess is that you are not a physician. It’s too easy to criticize someone or a group of people when you’ve never been in their shoes.

That’s not how no-fault works, particularly if you’re talking about workers comp. In that context, if you’re injured on the job, you are compensated for damages. The employer’s negligence is not an issue. In exchange, you get a specific schedule of damages.

What Kevin is talking about above is not very different from our present system, because someone is still going to have to try the issue of what protocol applied and was it followed properly. Doctors could just as easily promulgate rules nationwide using evidence based protocols, and agree that these would be followed, just establishing the standard of care clearly.

Yes. If an adverse outcome occurred because a doctor failed to follow evidence-based protocol.

Kevin

Yes. If an adverse outcome occurred because a doctor failed to follow evidence-based protocol?

Kevin

Second, people like you kevin should simply stop using the term defensive medicine. NO ONE knows what the optimal level of testing is for a given condition, let alone patients, so you can’t say when there is “overtesting.” Defensive medicine is simply a buzzword doctors use to scare people.

Further, as Gawande’s recent New Yorker piece illustrates (as well as a ton of scholarly evidence studying the effect on caps), its the economic incentives that drive doctors’ behavior–not liability concerns.

Third, a question for you . . . . immunity for following the evidence-based protocol is fine . . . but would accept the fair corollary . . . . automatic liability for failure to follow the protocol?