Saint Nate sends me the following:

I’ve interviewed a neurologist in Oklahoma who says that he has changed the way he practices significantly due to his fears of a lawsuit, particularly since he’s near the twilight of his career. When someone is referred to his office for treatment from a GP, he thoroughly screens the patient for risks and says he won’t touch any patients who show signs of comorbid conditions with their neurological conditions (epilepsy, Parkinson’s etc) and refuses to treat pregnant patients. When asked about the ethics of this, he said there are other neurologists in his area that invariably accept this population. He is also much more cautious with female patients of childbearing ages, asking them about their birth control precautions while warning them of the potential tetrogenicity of any treatments considered for their conditions.

He also seldom administers tPA to stroke patients. This is largely because he’s had some bad clinical experience with the treatment, which has lead him to believe it can lead to more harm than good, but he acknowledges the risk of lawsuits that frequently arises from adverse effects associated with this treatment. His view may seem controversial from an academic standpoint, but it’s actually not uncommon among the practicing stroke care community. One other member of “antithrombolytics anonymous” described tPA as “a sixteen chambered gun that has one bullet that kills the patient, thirteen blanks and two that offer a modest benefit.” The medico-legal aspect of tPA gives another dimension to those oft-repeated news stories about how rarely administered it is in emergency room situations, even when the patient presents during the three-hour window.

Defensive medicine is one of the leading factors in driving up health care costs today. The purpose of this series is to breathe some real-life examples into the numbers, and to provide some insight into how the threat of malpractice litigation pervades medical decision making.

Please e-mail me your stories of “how you practiced defensive medicine today”, and it will be posted anonymously as part of this continuing series.