Defensive medicine is estimated to cost the U.S. billions each year
Article Source: msnbc.com
from:msnbc.com9 in 10 docs blame lawsuit fears for overtesting
Seeded on Mon Jun 28, 2010 4:38 PM EDT (msnbc.com)
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This is why tort reform is so critical to reducing medical costs. I used to have a next-door neighbor who was a family practice physician who had just come out of residency. He told me one day that he had just personally ordered a wide range of tests, including a PET scan, for a patient that he was almost certain had a viral infection. His initial diagnosis proved correct, but the tests were ordered because the hospital-owned practice he worked for pressed the need as a defensive medical practice.
The net result? The tests were completely unnecessary, but they cost the patient and/or his insurance company more than $20,000. I similarly had a series of tests a couple of years ago. I have arthritis, and my doctor had taken some xrays to check some issues in my hip. There was some scaring on the bone from an old injury. Even though my doctor, the radiologist, and my doctor-neighbor all thought there was virtually no chance of a real problem, I went through thousands of dollars in testing, including a bone scan that required me to ingest radioactive materials. These examples are not all that rare; it's quite common for people to pay for exorbitantly expensive tests, sometimes involving exposure to radiation, purely as a way of mitigating legal risks for the doctor and/or hospital.
The people who say that malpractice suits respresent a small part of the costs of medical care focus that argument on malpractice claims paid; they completely ignore the many billions wasted on defensive medicine. Almost any doctor can tell you that this is routine practice.
--rorschach
Many people don't understand the medical profession. At any given moment a physicians decision can result in a favorable outcome or death. As a retired physician I remember an old Family Practitioner who was my preceptor during residency. He told me "a doctor is the only person who's most lethal weapon is,,,,his pen".
Everything from physician chart notes to tests ordered to prescriptions can literally kill a pstient. What he also told me was that regardless of how comfortable I felt with my diagnosis a "test of proof" was always necessary. Now if it was something as innocuous as a flu virus or an infected toenail you didn't have to order a thousand dollars worth of tests. But if a 15 yo football player came in after the game with a "concussion" diagnosed by the team doctor, chances are this kid was going to get a CAT scan or MRI. 95% of the time the test was unnecessary, Unfortunately that 5% of the time when anything from a skull fracture missed by the x-ray to a subdural bleed (bleeding in the brain) is what could cause the patient significant morbidity and mortality and ruin a good doctors career.
The first thing the plaintiffs lawyer will ask you after reviewing a case is how can the diagnosis be proved? If you have documentation and testing to support your treatment you were OK,,,,if not, years of depositions, court appearances, more depositions and more court cases could literally drown you in time lost and cost. Are there bad doctors in medicine? Yes. Just like there are bad engineers, bad welders and bad everything else. In medicine the problem is the lawyers and the plaintiff see "deep pockets". Deep pockets full of money from both the doctors and in most cases the hospital involved in the case.
Frivolous lawsuits are rampant in the legal profession. Unfortunately they cost the "patients" Billions of dollars a year. Yes the patients. There are over 1.1 million lawyers in the USA, and they all need to generate cases to make money. Many are very professional and honest. Many are not. Regardless, they all have to generate cases to make money. The cost of defensive medicine ranges between $85-$150 BILLION DOLLARS a year.
In our soon to be 4+ TRILLION DOLLAR health care industry 10% of that money will go to lawyers, not patients. This must be corrected otherwise no matter how much we spend on health care the budget will never balance.
what an absolute crock of @!$%#. The doctors own studies shows that they kill in the hospital (not including outside of it) up to 97,000 patients a year. Harvard School of Medicine studies (which doctors tout until the don't agree with them, at which point the very school which is supposedly the best medical school in the country becomes liberal and thus unreliable) show that only 1 in 10 patients who have actually had malpractice committed ever file a lawsuit. Do we need to talk about the Kaiser Foundation studies, which are again physican-based but yet all reach the conclusion that doctors aren't sued enough given the prevalence of the malpractice that actually occurs based on the doctors' own studies of case outcomes? How about you talk about those studies, Mr. Med-Mal defense lawyer?
Oh, by the way, in most jurisdictions, being a med-mal defense lawyer is the closest thing to being able to club baby seals that exists. It ain't hard to try those cases on that side. It takes not too much talent because no jury wants to believe that a doctor, who they absolutely depend on, might make a mistake. It is just that simple.
If there is a need for reform, it is reforming the bad docs. If you look at the stats, it is the same docs that get sued over and over again for doing the same bad things. However, docs protect docs, so nothing ever gets done. If you actually police the bad docs, the so-called "malpractice crisis" (which doesn't exist in any event -- go by and look at your doctor's house and estimate what it costs) will no longer exist.
Some called it "defensive medicine." Others call it opportunity to line the pockets. Still others call it plain capitalism. Some blame this type of medical practice on the legal system's propensity for malpractice suit while demanding tort reform. The real evil ones say it is justified as a way to get back at the insurance industry. The naive one says it is hospital standard operating procedure, "no skin off my nose." The best description is human greed.
Actually, it is a combination of all of the above and more. There's no doubt that doctors feel the need to PYA. There's also no doubt that attorneys see green when they encounter a bad outcome. And, there are doctors who see green when they order tests that they receive monetary benefits of.
But, the claim of capitalism is actually a bit misplaced. Can't remember who said it, but the phrase: "There is nothing more inefficient than one person spending another person's money for yet third person's benefit." It was describing government. But, it also applies to insurance companies. Both systems are extremely wasteful and fraud filled. Why? Primarily because the decision makers aren't making decisions about their own money.
Even the most diehard socialists will admit that if you want to cut the costs of medical care, make everyone pay for it themselves. Presently, how many of you discuss with your doctors how much a procedure or a test will cost and what are the risks of missing something if the test isn't done? We don't worry about a cost/benefit analysis because it's paid for by insurance or government. From the insurance or government point of view, their are schedules set up as to how much they will pay for each procedure or test. I remember going to a doctor to get a second opinion. I paid cash for the visit of $28.00. I had told the receptionist that I was paying for the visit because it was below my deductible. Well, a week later I get a bill for $125.00, less the $28.00 already paid. I called up and said I had already paid for the visit. They proceeded to explain that they didn't realize it was a "second opinion" and that the insurance company allows $125.00 for that and my co-pay was 20%. I told them, sorry, no way, I'd already paid the agreed price.
Well, the point is that as long as insurance companies are bringing in premiums and have investment returns that result in a reasonable profit, and as long as government has tax dollars coming in to pay the outlay, no one has that much of an incentive to cut costs. Since patients don't see a direct dollar for dollar outlay, they don't take action to be cost effective. Got a sniffle, well, if it won't cost you anything, why not go to the doctor just to make sure it's nothing major. If it will cost you, well, it's probably nothing, so I'll wait it out and see if it gets worse.
Another problem with the system is people's unrealistic expectations. For the most part nowadays, people seem to expect that the medical profession will guarantee their superb results. They even expect results even if they don't follow the doctor's advise. The fact is that the practice of medicine is an art, not science. A lot of what doctors rely on is what the patient tells them. Everyone is different in their ability to accurately convey what is going on with them. Doctors have to sift through it and determine what is really going on. Is it possible they are wrong? Of course! But, if you get 20 patients in who describe the same symptoms and they have the same thing except one has something much more severe, we have a tendency to blame the doctor for "missing" it.
Will malpractice reform help? Maybe. The problem is how do you reform it? How do you spell out in written words where you draw the line? The only place you can possibly do it is to limit "pain and suffering" damages. How can you draw a line on when a law suit should proceed in the first place. That can't be determined until close to the end, when a verdict is rendered. Very rarely will a case be thrown out on summary judgement before a trial.
More can be said, but, you get the gist of it.
witchrunner:
You said it best: With insurance it's $125.00. Without, it's $28.00. That's Capitalism...... the good ole fashion way, we milk and bilk it.
"We overtest because we have to!"
Nonsense. They overtest because it brings in substantial revenue. Med-mal cases rarely are based on a lack of diagnostic information. More often it is a failure to understand or comprehend the information already at hand, failure to take a proper history, misprescpription of contraindicated medications, or a failure to properly execute established procedures. Ordering tests that are only remotely called for is highly lucrative, even where the diagnosis is evident.
I really don't think its about the revenue, Chris. I'm certain it wasn't in the cases I specifically listed above. For one thing, the doctors in question were employees of a state university owned medical center. They were on salary, and didn't get any financial benefit from ordering tests. THe university made some money, but the doctors themselves had absolutely no vested interest in the tests other than a desire to cover their rear ends.
Ask yourself this; if it was about the money, why would my neighbor, in casual conversation, bemoan the need to cost his patients time and money by sending them for tests that he thought were unnecessary medically but necessary legally? Why bother to bring it up at all?
Some doctors are pretty mercenary. I get that. But a lot of them are good people, and the malpractice issue is a huge problem for them. The mother of my daughter's best friend is an obstetrician. I was talking to her a while back; she had a pending lawsuit at the time. She had a patient with a high-risk pregnancy where the fetus was at serious risk of birth defects, and she informed the patient of that. When the baby was, in fact, born with birth defects, the parents sued on the grounds that she was negligent in not specifically recommending termination of the pregnancy.
Believe it or not, I seem to remember that British courts have held in cases like that one that parents can sue on behalf of the defective child for pain and suffering that the baby would suffer as a result of not being terminated.
That's the kind of thing doctors have to protect against.
And by the way, I know bad things happen. In June 1983, my own mother received HIV contaminated blood during heart surgery and subsequently died of AIDS. After reviewing the case, I opted not to sue because this was before blood screenings were an established practice, and I could not convince myself that the doctors had truly been negligent or had acted in bad faith. Mom got five good years before AIDS claimed her, and it's five years she probably wouldn't have had without the surgery. I couldn't morally justify punising the doctors or the hospital after they had extended her life, regardless of the final outcome.
Malpractice is sometimes real, but often times suits are filed as a kneejerk response to loss and grief. People need to remember that when bad things happen, sometimes it's not anybody's fault. When it is a clear result of negligence, the responsible party should be held accountable. In many cases, the proper response would be to revoke the license to practice. The current system of lawsuits jacks up costs, but more often than not leaves the really bad doctors out there to hurt other people. Tort reform coupled with tougher standards on licensing might be a better idea.
--rorschach
"More often it is a failure to understand or comprehend the information already at hand, failure to take a proper history, misprescpription of contraindicated medications, or a failure to properly execute established procedures."
I agree with that part of your comment. I went to the ER with paralysis of the right side of my face, fearing I was having a stroke. The ER doc only considered stroke as a possibility after looking in my right ear and not seeing a "vesicle". He asked every question about stroke symptoms, which other than the facial paralysis there were none; but not one question about Bell's Palsy symptoms, of which I had them all. I had no weakness on either side, no slurred speech, no other symptom of stroke whatsoever. So he ordered a CAT scan of my brain, and three other tests along with giving me 6 baby aspirin. I didn't sue for misdiagnosis but I have almost $10K worth of collections on my credit report now because I refused to pay for the misdiagnosis.
Doctors are scared $hitless about being sued. My doctor mentioned that he doesn't prescribe an effective medicine because in his words it's become "lawyer bait". Lawyers go where the money is so as long as insurance companies have deep pockets and doctors can make the huge payments, this will continue.
It's pretty pathetic that the leftist press didn't advertise this before the vote, when it could have had an impact. It's not as if this hasn't been known forever.
One example: and there are dozens like this one;
There are 6 different brands of blood chemistry analyzers sold in this country, by the thousands, each year. Prices range from $30,000.00 to $50,000.00 based on sophistication. Each machine will generate between $50,000.00 to $100,000.00 in revenues for a Doctor, per year, depending on how often he uses the machine to confirm his diagnosis. How often do you think a Doctor who owns one of these machines uses it for protection against malpractice vs. lining his pockets and blaming lawyers????????????
Chris,
The vast majority of pysicians have no monetary reward to order imaging, blood work, etc. In most instances, you are sent to a hospital to get imaging studies and places like LabCorp for blood work. A few primary care offices can handle simple blood work in offices and do Xrays, some oncologists have there own PET scanners, etc. But, the vast majority have no vested interest in the tests they order.
I can not tell which tests are unnecessary they are now required as part of the work up of patients for completeness. Failure to test is always a possibility since there is always another test that could be done.
After 35 yrs, representing doctors in med-mal suits, I could not agree with you more. Overtesting supports an entire industry of labs, radiologists, etc. Lawsuits are mainly due to patient dissatisfaction with the doctor and the MANNER in which they were treated (combined, of course, with a poor outcome). And in court, only those doctors who do not change their attitude lose. This is why about 90% of cases are defense verdicts.
Doctors are reimbursed through Medicaid for every test they run on their patient. The more tests ran on each individual patient the more money the doctor is reimbursed through Medicaid.....This is caused medical fraud since Doctors run unnecessary tests on Medicaid patients in order to break even and make a profit.
The truth will NOT set you free. Tests are ordered by the doctor but done by a clinical lab or a radiology practice. The ordering doctor doesn't receive one penny for these tests. Where did you get your erroneous information from?
Cutter: You're a moron. They're running the tests as defense mechanisms for their expected lawsuits -- not to make money. That's the whole point of the story
myerspercussion, you're an idiot. Dthruth said that doctors get reimbursed for every test. They don't get any money for a blood test run by another clinic. The clinic gets that. How hard is that to understand. The doctor isn't making any profit by having those outside tests run to cover his butt.
Doctors are reimbursed through Medicaid for every test they run on their patients. The more tests ran on each individual patient the more money the doctor is reimbursed through Medicaid.....This is medical fraud since Doctors run unnecessary tests on Medicaid patients in order to make a profit.
Jeez. Read post # 5.1. Your certainty of correctness is belief driven with NO factual basis. You obviously dislike (to put it mildly) doctors. An ill informed or dishonest agenda should and is being called out.
Hi, I retired after worked for forty years. Never had I mixed financially with the hospital, laboratories nor other organizations. What did strike me was the cost of malpractice suits when it was over two billions paid out on 1970. Before I was made aware of 'malpractice' possiblilitiies, I had innoviated three new procedures which were adopted world wide, benefited millions and millions of patients. When the surgeon I worked for got sued, for something unavoidable, I found it so difficult to initiated any new ideas, or new procedures. Please help to cut down on the malpractice cases and the malpractice awards. The 'malpractice suits' had far reaching damages on the cost, the inventions and the courage of most physicians. Please help !
Just as comment to maybe help this discussion then, stop saying Please help! You doctors are an intelligent bunch, well, at least after all your protestations you are, and get the bottom of this and stop blaming everyone but yourselves and come up with some solutions. For example, define what you believe would be a means to determine malpractice or don't you think there should be any? Take your example, what was unavoidable and how could this be used in a discussion to allow doctors and patients understand each other well enough so that this could be solved without going to court or if it does go to court, so that the limits protect both sides. The discussion tends to be a little one sided for the doctors for as you have seen in this initial list of comments but doctors in this country (they do much better in other countries) don't communicate very well and just to say, just ask any questions doesn't work well with the superior/inferior relationship that exists between doctors and patients now. For example, when a doctor started going over all these additional things he should be doing for me which were very far away from what I was seeing me for (helping me I guess, but not really), I asked him how much. He said he didn't know but the insurance usually paid for it. I told him "Wrong Answer Doctor". Would you take your car in to get it fixed and be satisfied with an answer like that? You doctors should know how much its costs, you should not depend on insurance to pay for it for you are supposed to be in business and a doctors office is not run like a business. The doctor wrote me a letter and said that he would no longer treat me because I had scared his staff.....his right not to treat me, but I don't think his scared staff was why he didn't want to see me...then, what I had gone to see him for, has come back and I am finishing up surgery and radiation...what do you think...should I sue him because he didn't do what he was supposed to? This is the real question with malpractice...what is malpractice? I think patients think that it should be being healed and not going broke and the doctor is that the patient doesn't die and how much does the insurance pay for.....might that be some of the communication problem? (Oh, I am not suing him...his lawyer should not get any of my money)
I don't know how I stand on this at the moment.
Doctors are damned if they do, and damned if they don't.
Right on spiller. The democrats can't have it both ways - medical care for everyone and unlimited lawsuits against doctors. Lawsuits against physicians don't happen in other western countries to the extent that it does here in the U.S. Texas limited liability in lawsuits several years ago and it's surprising why other states do not do the same.
shark, all the other Western countries have Universal Health Care and limit lawsuits to actual damages because the crappy Doctors who work on the "piece work" system get fired. You know the piece work system, "the more meat you cut, the more $$$ you earn".
All you wise people who ascertain that the said "unnecessary tests" are ordered for profit...please tell me where in the country I can get paid for this and I will have my bags packed in the morning and move there...
Examples have been posted. Want to know about pulse oxymetry, office EKG's, dip stick urinalysis and sygmoidoscopes in Doctors offices????
As a practicing emergency physician for the last 8 years, I have watched our malpractice premiums skyrocket. It was to the point where our group had to take a risk and invest in creating our own LLC because we could not get insured. Our premiums were higher than neurosurgeons for the simple reason that emergency medicine is not predictable. A neurosurgeon has complicated patients and sometimes bad outcomes, but those rates are fairly stable from year to year. An emergency medicine physician can go for years without the slightest problem, and then one 36 year older shoulder pain patient turns into a missed heart attack and the value of his entire career is awarded despite doing all the appropriate testing.
The American population, in general, and maybe other populations as well, have a great deal of difficulty with insecurity and unpredictability and randomness in life. And if something goes wrong, it should have been forseen and someone is to blame. And there is an industry ready to take advantage when it does and its presence is seen on TV every single day.
Lastly, modern media has led to an extremely anxious and fearful population. The patient expects, and even DEMANDS, the CT scan that will let them rest easier. When I patiently try to describe known risk factors for dangerous head injury such as loss of consciousness or onset of repeated vomiting within an hour of injury the patient usually nods and then replies 'but look at what happened to Natasha Richardson!' The CT scan is usually ordered and is negative. But they were not leaving without it. (And to risk making the patient unsatisfied means risking a complaint letter and drop in Press Gainey scores which makes hospitals unhappy and a conference with the offending physician takes place.)
Lawsuits are a huge factor, and at least in the Emergency Room (I don't get compensated for xrays or lab tests), patient expectation is even bigger.
A. If you had a patent in the ED for increasing abdominal pain and they have been seen multiple times, at the same ED, same symptoms, with negative test results. Would you review their medical history or run the same test again?
B. If the patent had just left their regular doctors office, would you consult their doctor, prior to committing to more test and stronger medications?
C. Or would you hide behind HIPAA and run your 20+ step verification, ignore the previous results, and rerun CT scans/pelvic exams/etc?
I know your answer. "C"
The end result was the patent was having anxiety attacks, as diagnosed by their personnel doctor. But the ED doctor prescribed narcotics for the pain and a medication that lowered their susceptibality to SUICIDE.
The Physiologist findings - excessive medication resulted in a psychotic event, no previous history of any mental problems. The ED doctors have no liability. Due to side-effects of the medication, common mis-diagnosis, and not financially attractive to any lawyer.
I'm sorry but other Professionals and trades people are held accountable for their MISTAKES. Unless you are a CEO, Lawyer, or Politician. More than 80% of mis-diagnosis cases never reach the court system.
Something in that Oath you took about not making things worse?????????
"The end result was the patent was having anxiety attacks, as diagnosed by their personnel doctor. But the ED doctor prescribed narcotics for the pain and a medication that lowered their susceptibality to SUICIDE."
First of all, if you are going to make any argument, let alone a hypothetical one, perhaps you should recognize that a person has a personal physician and not a personnel physician. The fact that you so easily overlook something like that leads me to believe that you have little education, and absolutely no right to assume the physician in question would elect "C" as the most likely option. My second point; are we to assume that the "personnel physician" has better insight than the emergency physician? If we were to look at the competitiveness of the profession along with average USMLE board scores going in, you would find that the emergency physician may indeed have better insight based on higher scores. Now is that always the case? No, assuming so would be ignorant. You need to realize that a lot of the people that end up in the emergency department are there because of something that the aforementioned "personnel physician" did not pick up on.
Thanks for the entertaining diversion from pharmacology!
I will be glad to put my eight years of college GPA, years of military schools, EMT training, and GCT against yours. Then you can retire at 50 like I did, ten years ago. Maybe you should look into being a sectary.
Obviously a Nurse Practitioner could read medical charts and come-up with the correct diagnosis. Without covering their A$$ with repetitive test, that ALL showed negative results.
FYI, A Doctor in Thailand has undone most of the damage that resulted from the FINE medical care the US doctors preformed.
From my families experiences with the US medical care, US doctors deserve to be nationalized like BHO is going to do..... Ha! Ha!
Eight years of college? It didn't take me that long to get into medical school. While getting that training I also received training as a paramedic (which, by the way, gives you little power of opinion in medicine). Military school? I wasn't aware that they gave training on the assessment of sound medical practice. If you want to make an argument give me some hard data, not some testimonials. Who gives much thought to things that go right all the time? People always hear about what goes wrong, and not about all of the things that occurred uneventfully. That is a little thing known as recall bias.
U.S. doctors will never be under nationalized medicine; sorry to disappoint you. They will continue to make well deserved salaries (a lot of them are underpaid considering the $250,000+ they typically take out in loans in order to get trained) for the sacrifices they had to make in order to become physicians. Financially, I will be able to retire by the time I am 40, but I will likely work until I am 60 or so. That is because I love what I am doing, and wish to continue to help fine people like you, regardless of whether or not you believe that people like me are doing our best to manage your health. :-)
It is good to hear that people can still afford to stay retired. Congrats!
The relationship between the doctors and malpractice lawyers is akin to the relationship between the wolves and the caribou. They both need each other to keep the other strong and from over grazing.
What the Congressional Budget Office said, and the president reiterated, was that tort reform cost savings would be negligible, they are wrong. They look only at the awards in malpractice suits, what they choose to ignore (partly because they don't want to deal with 40% added cost possibility) is the over treatment cost. I think it is an anomaly, providers apparently feel their career is in jeopardy, I'm sure hate getting dragged into court and being blamed, as they are human like everyone else but singled out as critics rule--as if a different race does the president understand. The system strayed from the perspective of getting the person well--best health outcome should be #1. Glad they made this survey.
Kirk asked for some specifics on malpractice and here ya go. One problem with malpractice cases is that a physician may personally get sued for a known complication of a procedure even if he informs the patient that they may have that particular complication from the procedure. Furthermore, the physician may get sued even when the procedure was performed for appropriate indications. How in the hell is that fair for physicians? I want to hear from some of you trial lawyers out there on this one. As much as you don't want to believe it, this does happen. No way should a physician be dragged through personal hell for this.
Move to NC, common mistakes are not considered malpractice.
I'm sorry, I fail to believe the lawyers in NC are that benevolent.
I'll be glad to give you the NC lawyers names that have stated that.
The N.C. and Va. legislatures passed laws limiting liability years ago. The only way a victim of malpractice, or negligence on the part of a company, can get even their medical bills reimbursed is if the offender chooses to allow their insurance to pay. Lawyers will not go to court in those States, no matter how outrageous the harm, because the law prevents them from winning damages. Be careful what you wish for wing nuts, you might just slip on a tea bag and find you have no one to pay your medical bills.
My husband is a physician, as are almost everyone I've met through him. Aside from 2 who came from very wealthy families and are therefore fully funded, none have been able to afford to set up a practice because of malpractice and insurance administrative costs. (And one of them ended up merging with another practice to spread out costs.)
BTW, this is why there are not enough mammography specialists. It's got one of the highest malpractice costs and lawsuit risks.
If something does not have a favorable outcome and there was some new, overpriced test or medication that is slightly better than the standard, some lawyer will claim negligence for not ordering it.
If you order unnecessary tests, medications, biopsies, or procedures, you get slammed. If you don't, you get sued.
It is called the "free market" Ginger. Which model Mercedes do you drive dearest???
I don't. I drive a Honda Civic, which I do not keep in Manhattan because of parking costs. Generally, I take the subway.
My husband opted to work in academia instead of private practice because he wants to contribute to research and training new physicians. Which means he makes about half what he otherwise might.
So, dearest, what exactly does the free market have to do with what I posted? Does that reference the radiologists afraid to touch mammography, or the doctors choosing between wasting healthcare resources on unnecessary treatments vs getting sued for not piling on the latest and greatest, just in case?
If tort reform were the answer then would not the states that had already implemented such have markedly reduced malpractice insurance rates as well as malpractice lawsuits? They don`t however and therefore I don`t really think tort reform will be sufficient.
Besides it is only a band-aid for more serious problems we have as a society..... what to do with those that are disabled for whatever reason. A friends family is suing the surgeon whose work resulted in paralysis of the adult son. Did he make a mistake.... well obviously because the guy is now paralyzed. Was it intentional? Well, No. Was it to the level of malpractice.... a jury will make that determination. However, this person is left on social security disability and medicaid. Neither are sufficient to provide the level of care he needs for the remainder of his life. His parents are elderly and cannot deal with the care he needs nor do they have the wealth to support the care that he will need into the future and beyond their lives. The lawsuit purpose is to get enough money to allow him to live. It only works because of a miss in the surgeon`s briefing to the guy before surgery. Most people don`t have something like that in the records to even begin the lawsuit process. That is a sad commentary on our society when this is what it comes to.
As for over testing and too much care? I have witnessed both with family members. I personally now believe that a lot of this is because the medical professionals get paid by the procedures and tests versus the outcomes. Mom was having quarterly CT scans on a spot on her lung found during a CT for another problem. This went on for two years until she asked the doctor (at my prompting) what had changed, what he was looking for and how long it would continue. All of a sudden those CT scans were no longer necessary. Dad was offerred treatment for end stage cancer in the last two weeks of his life. After he died I researched it and figured out that the stage of cancer and his age made survival or even improvement Nil. Yet the radiologist billed $10K for two or three doses of radiation. Didn`t see the chemo bill but no doubt that was at least as large. Medicare paid for it all without question. Someone was making money off this dying man. Yet, my Aunt who had the same cancer with the same time left was under the care of a doctor/facility where they were paid a salary and did not make more money off her treatment. He was more forthcoming on the prognosis and did not push more care. She died in the same amount of time as Dad did.
Out of curiosity, if they doctor had not done the followup scans, and the spot ended up being lung cancer (which is rarely curable once symptomatic, when they are usually found), what would you be saying today?
I agree with you about society taking better care of our disabled. It should not require legal tricks and a the decision of group of people without medical training for someone who is disabled (for whatever reason) to receive proper care and a livable level of financial support.
Lawyers are a necessary evil. Citizens are not much better. People don't recognize when they have done something wrong, life is what it is, circumstances etc. Someone other than themselves must be blamed, and so here comes a lawsuit. Until we have legislation that the individual who sues must pay ALL court costs if he loses, this nonsense will continue. We will soon lose doctors or any other professional that is constantly sued because of the greed of the plaintiff and the lawyer. We teach our children to be victims with these lawsuits. And those that should receive compensation, don't want that. They want to become instant millionaires. I'm sure we have people coming to this country with that mentality. After all, we are "the land of opportunity". Especially if you "accidentally" fall down somewhere and blame anyone; get rich without even trying.
just to clarify for everyone- doctors are not paid for ordering tests or procedures. if dr x orders a ct scan read by dr y then dr y is paid for reading said scan but dr x gets nothing. this myth is featured heavily on this post and should be refuted. the only way a doctor would make money by ordering tests would be if that doctor had financial interest in the facility ordering the test, a violation of what's commonly called "stark law" - starklaw.org.
As an ER nurse for 20+ years, I know for a fact that some ER are rewarded for ordering as many "justifiable" test as possible. At 2 hospitals I worked at, the physicians were not employed directly by the hospital, instead contracted as part of a group. Their pay was contingent on Patient Satisfaction Scores and also the acuity of the patient. Acuity was determined by among other things, the diagnostic tests utilized to diagnose the patient. Needless to say at these 2 hosptials (both using the same 3rd party providers), I wittnessed more testing, more treatements, and more narcotic pushing (gotta keep 'em satisfied) then any other places I've worked. As a traveling RN, I've worked at well over 30 hospitals around the country.
With this said, I also believe that tort reform is needed. Every kid that comes to the ER with a bump on his head gets a Cat Scan for fear of missing something and winding up in court. Every kid that has GI symptoms gets IV fluids, antiemetics, antibiotics, etc...because of the fear of upsetting uneducated parents. As a result, patients are in the ER much longer then truely needed causing a backlog of patients which leads to less time spent with each patient and more chance of mistakes being made.
Everyone wants to blame the physicians and other healthcare professionals while the general public is allowed to remain ingnorant and fat with a cigarette in one hand while the other is waiting for a handout.
sorry- financial interest in the facility PERFORMING the test/scan, apologies for the error in the initial post.
We have 5 docs in the family ranging from small town family practice to large city pedeatricians. They continually complain about the cost of malpractice insurance and how afraid they are of being sued. (I realize this is only a sample of 5) but I asked them if they had ever personally been sued - NO. I then asked them if they knew of anyone who had been and the answer surprised me. Like some kind of urban legend they all knew someone who knew someone who was sued out of existence because of some everyday error. I was dumbfounded and I tried to get at the facts. What I found was that most of the lawsuits are caused by drugs that should have never been approved in the first place or in the case of surgery an implant or something with no benefit. It's the drug manufactures and medical device makers that get hauled into court and wind up dragging in the Docs with them.
"Mom was having quarterly CT scans on a spot on her lung found during a CT for another problem. This went on for two years until she asked the doctor (at my prompting) what had changed, what he was looking for and how long it would continue. All of a sudden those CT scans were no longer necessary." So much ignorance and so much suspicion of Drs. motives. FYI, pulmonary nodules that do not change in 2 years are considered benign. That is why she was followed up for 2 years. If your doctor did not do the followup CT scans as per CURRENT PRACTICE GUIDELINES, and later that noncalcified nodule turned out represent an early cancer, which then went on to metastasize and be incurable, you would be screaming for doctor's head.
Doctors do TESTS, because that is the only way you find out what sort of disease they are dealing with. They need to know that before they can TREAT the problem. Sure, only 1 out of 100 people in ER that show up with "worse headache of their life" turn out to have an intracranial bleed, but missing that one case by not doing a CT scan will cost about 7 million dollars, so what is the poor ER doc supposed to do? Play roulette with his medical license and career? He is not even insured for 7 million, most likely 1 million. So the enterprising attorney will go after his personal assets.
Basically, in this most litiginous society in the world, the only way to minimize Drs risk of malpractice is by doing always MORE than less. That will not change until we have death panels and such structures, backed by new laws, and then you will NOT be allowed to sue such a bureacracy, just like veterans cannot sue the VA.
I personally think we should have a government run fund for all medmal cases, just like there is currently a fund for those rare few who are harmed by vaccinations. It would be much cheaper for our society in the long run. Take out the financial gain for attorneys and remove all the "pain and suffering" out of the equation. Healthcare workers do not plan to harm patient, but in medicine complications are guaranteed to happen; we are humans, and humans will always make mistakes. Nobody is perfect. Therefore healthcare can never be perfect. Even robots go bad.
this is a real problem.
i live in a state were there are doctor owed hospitals so don't tell me about the stark law.
many hospitals also use private dianostic clinics for the patient. currently i have no insurance and have been dealing with intestinel problems that may have come from a history of survere acid reflux. i suffer from severe gas and constipation ect. after seeing several docs, then a gas doc, i was told they can not make any diagnosis unless i'm willing to have several additional exspensive test done. i asked why and i was told they want to know if there is cancer before treating anything else. so after several hundereds of dollars i know nothing just to protect there ass and i don't have the big bucks to sue them any how. so maybe money is at the hart of this for docs.
tort reform has done nothing here in texas, just ask the docs here they will tell you how after it passed their premiums shot up!!! so research some about the dambing effect of tort reform, it is a con.
True - they did shoot up. My brother-in-law (family doc) saw a 33% increase. When he told them he was going to shop around they told him not to bother because there was only 1 other insurer in the state and their premium was the same. He has since quit the AMA.
Kfresponse, I feel your pain (quite literally, heh). I have ulcerative colitis and severe nausea that leaves me unable to eat for days at a time. However, I lost my insurance and my gastroenterologist says that she can't prescribe me any more medication until I get a whole mess of tests done that I've had done before. How can I afford that??? So I just have to sit here and suffer through everything, and it really pisses me off.
I don't even want to think about how much I've cost the health system with all the (what I consider to be) unnecessary tests I've been ordered for my numerous chronic illnesses. And guess what? THE RESULTS ARE THE SAME EVERY.SINGLE.TIME.
But I do understand the quandry that doctors are in. Medicine is not an exact science, and in our sue-happy culture, they need to cover their asses. It just makes it so much harder for the rest of us.
just to clarify for everyone- doctors are not paid for ordering tests or procedures. if dr x orders a ct scan read by dr y then dr y is paid for reading said scan but dr x gets nothing. this myth is featured heavily on this post and should be refuted. the only way a doctor would make money by ordering tests would be if that doctor had financial interest in the facility ordering the test, a violation of what's commonly called "stark law" - starklaw.org.
that is only partially true. I agree if hospitalist or ER doc sends a patient to the lab, he gets zero income in return. BUT. plenty of doctors or doctor groups buy their own lab equipment, xray machines, ultrasound and cardiology equipment, MRI, etc., put it in their office and then run their patients through it. they are EXEMPT from Stark Law, there are no kickbacks involved, but it has been shown that such a self referral utilization is several times more likely than if they do not have this equipment and have to send their patients to some other facility. orthopedists, internists, cardiologists justify such purchases by saying that they provide a prompt care for their patients, but that of course is BS.
not that I blame them that much, government is always finding a way of not paying the bill, cutting Medicaid and Medicare to bone, so the doc may actually lose money by seeing a patient in such category, so doctors are looking for creative and legal ways of getting income elsewhere.
the latest government FIASCO this month was that Medicare simply did not pay ANYTHING that they owed to doctors (processed no claims), while waiting to see if Congress will keep or reverse the 21% cut in Medicare payments. what business can survive if some giant payor arbitrarily decides that they will put all payments on hold? if you have 50 or 70 percent of your patients in Medicare (e.g. internist specialising in elderly) and the government decides that they will cut their lousy payments by another 21%, what does that do to your practice?
Many doctors do have a financial interest in a pharmacy, lab or imaging center they send you to. If you read the fine print in all those papers you sign, you will find this disclosure mentioned. In California anyway.
Patient sitting @ home, watching TV. "Do you have painful, stiff joints? Have you been diagnosed with arthritis? Then ask your doctor about (insert name of drug).
Patient goes to doctor.
"Hey doc, I saw a commercial for X drug, and I want it."
Doctor - "Well, sir, that medication has only been on the market for a short time, and sometimes problems with different medications aren't immediately apparent. Why don't we try Y? It's been recognized as an effective treatment for arthritis for decades."
Patient - "No, the television said X was better and I want to try it!" Doctor prescribes medication X.
Five years later.......patient @ home watching television recovering from heart attack. Another commercial. "Have you been prescribed medication X? Have you taken medication X in the last five years? Have you suffered a heart attack or stroke since starting medication X? If so, then call XXX-XXX-XXXX and talk to a member of our legal team about what we can do for you."
The problem with health care is not only a few bad doctors but also our national sense of entitlement and lack of personal responsibility for our own decisions.
Hey everyone, calm down. The new health care bill ramrodded through by Obama and the democrats addresses this problem.
What? What's that you say? You mean it doesn't address this problem?
Damn.