“Not. your. job. And it never will be.
Your job is to offer optimal care, for an INDIVIDUAL patient’s INDIVIDUAL circumstances, always.”

What about that fourth principle of ethics that we so often ignore – social justice? Healthcare is a limited resource whether we like it or not. We focus so much on autonomy that we do so at the expense of social justice. We allow some people to have “everything” which may leave nothing for others. While I advocate for my patients to the best of my ability, I do think that doctors AND patients need to be more aware of the limited resources we have and the need for allocation to acheive social justice.

Thus representing less than 10% of practicing American physicians? Give it up. Greedy doctors are not the reason for overtesting. A culture of CYA and “do everything possible” has emerged from a combination of the most lawsuit-happy system in the world and aggressive marketing of technology. Changing that culture will only happen if either the malpractice system changes or the government imposes strict limits on what it will pay for.

Patients won’t be able to stomp their feet and demand “more be done”, they can’t argue with a computer after all. Docs won’t get sued, we would just be following protocol after all. Cover-your-a** orders won’t be needed. Docs would only be sued if they deviate from e-standard of care and deviation (i.e. thought) wouldn’t be allowed.
Since inappropriate or redundant tests won’t be allowed, risk and guilt-free limited care will result.

I have been misdiagnosed 5 times, two of which lead to a permament disability. I didn’t sue. The one that showed compassion is still on my medical team despite his mistake. Perhaps I should sue the others.

If I had an undiagnosed PE and died, I don’t think I would sue.

Of course, you point above is that patients drive unnecessary cost. (Is piece of mind for a scared individual really unnecessary as you imply?) I didn’t ask for the CT and the doctor is responsible for the unnecessary CT.

The physician is part owner in a multi-specialty group.

Unless you were seeing a radiologist for diagnosis and treatment of your DVT, the physician who ordered the CT didn’t make one red cent by doing so. This is a classic example of CYA medicine, and it is an enormous burden on the system.

There seems to be an increase – over the last few years – especially in Pediatrics – of people/family members coming into the hospital/ED and making a scene/copping an attitude/causing a stink/threatening to sue – in order to get what they want – never mind that they often don’t really know what they want.

It oftentimes interferes with the care of the patient. If a staff member (nurse/doctor/whatever) is afraid to walk into a room for fear of getting their head chewed off, they’re going to avoid the room.

A good portion of the time, those exhibiting the worst behavior are on public assistance and do not want to pay for any of the expensive/unnecessary things they want (and I’m sorry, if you really want to talk about reform, this is an expectation now passing from generation to generation that the government has bred).

The doctor/staff caves (be it with ordering labs/tests or transferring someone somewhere they don’t need to go) just to keep the peace/get through the day and try to take care of the patient.

In effect, bad behavior is rewarded.