Bad Medicine

Related Post Roulette

3 Responses

  1. Avatar Michael Drew
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    says:

    We should heed the good doctor’s observations. They are critical. I have long been skeptical that as much of the unneeded treatment and diagnostics we have in the system are a result of fear of lawsuits as is often claimed. Dr. Summers’ suggestion of ways in which excess creeps naturally into physicians’ practices is illuminating and especially persuasive for being confessional. Though he doesn’t say so explicitly, I think he also alludes to the important point that even when out of fear of being sued doctors practice unbeneficial, wasteful ‘defensive medicine,’ they are still partly responsible for that decision — endless waste can’t be justified simply because of the possibility of one day being sued; it is a high-risk profession to enter after all. Moreover, even if a cap on the highest awards (the most likely and most-suggested tort reform) is imposed , the experience of being sued will get no less unpleasant and there is no reason to believe the number of suits filed would come down. It seems to me that unnecessary defensive medicine — regardless of to what extent it really drives costs today — will be with us as long as doctors choose to practice it and are allowed to do so.Report

  2. Avatar Gadfly John
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    says:

    Hi, Dan, interesting read, as usual.

    I’m curious if the various moving parts of healthcare reform might be separated, just for clarity’s sake, when Congress makes bills. Anyone in engineering will tell you that doing several small-to-medium scale projects is much easier than rolling everything up in a big, hard to understand project. For example, tort reform to reduce defensive medicine can stand on its own. No reason to delay tort reform while, say, insurance portability is debated. No reason to back off eliminating waste and abuse in Medicare because consensus on IMAC scope is hard to achieve. I’d certainly prefer to see 8 to 10 50 page bills rather than a single 1000 pager.

    Also, I’d also prefer to know before we cast it into law just what the scope, and ideally the end result, of these clinical boards might be. Are we going to get an IMAC-ish all-or-nothing recommendation? Why aren’t current medical bodies providing recommendations or establishing standards of care? What knotty problems, if any, make such standards require government’s backing rather than, say, the American Board of Pediatrics? I’m not a physician, but inquiring minds want to know!Report

  3. Avatar PookieMD
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    says:

    I have to differ with you on a couple of points. We as physicians seldom order a test because we are afraid of a malpracetice suit. Rather, there is a prevailing standard of care in our communities such that certain tests get ordered for certain conditions. A classic example is that of chest pain: most ED docs admit patients with chest pain, no matter how low risk. There is no incentive to send these patients home, as missed MI is a top 5 most sued event for ED doc. In addition, community standard of care may dictate ordering of a CT Chest for r/o PE. The ED doc can’t be faulted, nor can the hospitalist who then orders the nuc med stress test. It is the prevailing culture to order all these tests, and the prevailing standard of care. Evidence based medicine doesn’t hold up well against the prevailing culture. Picture: “Well gentleman of the jury, Dr. X didn’t order a CT of the chest because she thought the pretest probability was only 5%.” It just doesn’t fly in the face of community standard of care and culture.
    To that end I must disagree with Dr. Drew as well-Americans DEMAND all the latest tests and technology and are quick to seek lawyerly advice if they preceive they received anything less.Report

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