Defensive medicine from the frontlines
Think defensive medicine is a non-factor? Read on:

* “We no longer let patients who have inadequate prescription coverage rely on our sample cabinets,” says Jeff Kagan. “Take what could happen if we regularly supply samples to someone with a heart condition: If we run out and the patient has an MI or a stroke, he’ll sue us for failure to give him sufficient notice that he’d have to find another way to obtain drugs.”
* “Complex or risky cases are referred out,” says FP Craig M. Wax of Mullica Hill, NJ. “We’re providing less charity care due to the rise in costs and decreasing reimbursements.”
* “I’ve stopped doing hospital and nursing home work,” says FP Frederic F. Porcase of Jacksonville, FL. “And I dismiss noncompliant patients. For example, when a longtime patient at risk for an MI refused a treadmill stress test, I showed him the door””not because I thought he would sue me, but because I thought his family would if the worst happened.”
* Richard Lafleur’s internal medicine group in Derry, NH, now has a “no treat over the phone” policy. “If the patient can’t come in, we document referral to the ED,” he says.
* In addition to avoiding personal injury cases because of his suspicion that such patients are more litigious, Melvin H. Kirschner, an FP in Van Nuys, CA, does more tests and makes more referrals than he once did. “And I try to have personnel in the exam room with me and the patient so that the staffer can testify to what I said and did should the need arise,” Kirschner notes.
* Sioux City, IA, emergency physician Tom Benzoni admits to doing 70 percent more tests than he thinks necessary, including blood cultures and chest X-rays, on all patients who come in with chest pain, and L-spine films for nontrauma-related back pain.

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