The malpractice risk of high deductibles

As the cost of health insurance rises, patient deductibles are getting bigger.

More doctors are reporting that patients are coming in less frequently for chronic care followups, skipping medication refills, or balking at the out of pocket costs for various tests.

Sometimes, however, this can get physicians into trouble.

I was reading through a copy of Massachusetts Medical Law Report, and saw this story of a primary care physician who was sued for not offering colon cancer screening:

A 65-year-old man was belatedly diagnosed with cancer of the sigmoid colon, which caused his premature death.

From 2002 through 2006, he was a patient of the defendant. It was undisputed that during this time, the defendant neither offered nor performed a complete physical exam, including but not limited to colon rectal cancer screening.

In June 2006, the patient presented to the hospital with complaints of abdominal pain for the past several hours and no bowel movement for several days. An abdominal pelvic ultrasound showed free air, while a CT scan confirmed free intraperitoneal air consistent with a perforated bowel.

The patient was taken to the operating room emergently and underwent exploratory surgery, which detected the stage IIIB colon cancer. The disease was later found to have spread to his lungs. His condition deteriorated and he died in April 2007.

A tragic case, for sure.

But further down the article revealed the reasons why the physician didn’t offer screening:

[The physician] claimed that the patient was only seeing him for blood pressure checks, and did not want a “full PCP.” He was a private-pay patient and had declined any further medical services.

The case settled prior to trial for $1.5 million.

Unfortunately, this scenario is sure to rise as both the cost of health insurance and the unemployment rate rises. More patients may be willing to put off that colonoscopy if it’s not covered by insurance.

Doctors need to explain the risks of skipping these tests, and follow through on whether they’ve been performed, or not.

Just as important, if the patient declines age-appropriate screening tests, that needs to be documented in the chart, along with whether the patient understands the medical ramifications of their decision.

 is an internal medicine physician and on the Board of Contributors at USA Today.  He is founder and editor of, also on FacebookTwitterGoogle+, and LinkedIn.

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