Defensive medicine op-ed reaction

Thanks for all the feedback for my defensive medicine op-ed in yesterday’s USA Today: Wasted medical dollars. Here is a sampling of reaction:

“The other factor at play is the somaticizing patient. The cost of these patients should not be overlooked in discussions of defensive medicine. I’ve certainly ordered too many head MRI’s and abdominal CT’s for stressed-out patients. But it’s so easy to get ‘cornered in’ to ordering the MRI for the patient with migraines, or the CT or colonoscopy for the IBS patient. We all need to work on educating ourselves to deal with these patients in a more cost-effective manner.”

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“Emergency medicine is an enormous sink for defensive medicine dollars, and frankly I’m not sure ‘evidence-based medicine’ or algorithms are helping. Sometimes, we need that gut feeling that says do it, or don’t do it, sick or not. Sadly, many docs with high rates of malpractice, or complications, simply practice high risk medicine, like inner-city trauma care or obstetrics. Cherry picking leads to less problems, less suits, but also less access.”

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“I would agree that until the malpractice system changes, defensive medicine will continue to be practiced. The other problem is that, even if a patient has a good relationship with a physician and is willing to forgo various diagnostic tests, the family can decide to sue later if there is a bad outcome. I suppose one could carefully document that the patient was explained the risks and benefits of each test and declined the test, but it is far easier to just order the test. For as long as the risk of arbitrary lawsuits is high, and physicians get paid for services (whether or not the services benefit patients), we will continue to get the status quo.”

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