That depends on whether you are counting gross profits, or net profits.

Those of you who believe this is all about making are sadly mistaken and do not have a clue on how regulated doctors truly are. You criticize the fees (which are not set by the physician when they PARTICIPATE with insurance plans) and the cost. Until your sick and need help. Then you love your doctor - until the bill comes in the mail! Then the doctor becomes a crook again! The real pigs in the healthcare system are the profit driven insurance carriers, the slimy ambulance chasing trial lawyers and the patient who thinks a malpactice suit is a winning lottery ticket. If the doctor is guilty of malpractice then he or she should pay. If the plaintiff has brought a frivolous suit THEY should pay ALL court costs, including the defendents! Watch the number of cases decrease dramatically!

Insurance industry profits are up 41 percent during 2010. I couldn't post the url. Either too dumb or the site wouldn't let me.

well said Joe....If you bring a suit and lose, you pay. There is currently no DISincentive to bringing a suit.

Uh, Jackhmd, making you pay for losing a law suit is a direct violation of the 1st Amendment. So, I don't think you'll see it. Joe, Insurance Companies negotiate with Hospitals and Doctors to arrive at the prices they will pay. They don't tell doctors what they will pay. It is this schism that has resulted in a bloated, ineffectual health care bill. You have to have limits on malpractice torts if you want to reduce health care costs. Period. You also need to address Doctors and Pharmecutical companies if you want to lower costs. There is no "Silver Insurance Provider Bullet" that will lower healthcare costs.

That is right about hitting the lotto-we see patients in the ED all the time that come in over and over looking for something to be wrong with them for three different reasons:

1. They want to get a disability check and/or narcotics

2. They want to sue someone for their car accident, their slip and fall at wal mart, or they want workmens comp for their back injury(if they actually work).

3. They are waiting for a doctor to make a mis diagnosis or mistake, then they will sue for the lotto!

The sad thing is, they are usually on medicaid, so we pay for their repeated visits to the ED. After all, they don't have anything else to do....nothing on TV!

Uhh....Zoro...how is that a violation of the first Amendment?...I didn't read anywhere in it that falsey accusing someone is protected by law. And, by definition, if you bring a lawsuit and lose, it is false!

Most malpractice law suits come down to the Plaintiff's whore experts vs. the insurance companies whore experts and a jury that has no idea what they are talking about -- is the mood of the jury against sueing doctors -- is the jury sympathetic to the Plaintiff? It's a crap shoot, often w/o reason. Assessing attorneys fees for bringing such a suit would only deter people from bringing legitimate claims. You cannot imagine the number of malpratice cases I know of where the jury has just gone haywire. If you pay attention, you will see that the insurance companys always demand a jury trial. I wonder why.

Every other aspect of civilization has advanced. Not the legal industry.The American legal industry is running off of a thousands of years old Roman Senatorial adversarial process paradigm. If any other industry failed to do as it claimed as badly as the "Justice"industry, they would be sued out of business.

Domestic court makes more money, exploits more children, and does more damage than the child pornography industry (I have proved that from figures from the DOJ and exploited children's sites).That's a veritable crime against nature, and THEY are the CRIMINALS.

And look at all of the "death row" criminals that have been released on DNA evidence. It seems as though the worse the offense, the more likely the prosecution is likely to convict an INNOCENT man. And believe me, I'm NOT a bleeding heart liberal. I would go for much harsher treatment of CRIMINALS in a heartbeat, but not when we are putting innocent people, pot smokers, and "child support" victims in jail.

Whether the courts serve justice, the people, the country, or the best interest of they children is ALWAYS arguable. What is NOT arguable is that their policieis, procedures, and guidelines serve THEMSELVES.

Personally, I think every other major industry (or maybe the whole damned population) needs to form a coalition and shut their doors, even if that shuts down the country, until our corrupt, perverted, tyrannical legal industry figures out how to get truth into a court room and get justice out of it. That includes ALL areas - civil, criminal, domestic, tort, etc, etc, etc. A minor upgrade will not suffice. At this point, I believe a major paradigm change is in order.

Lawyers, what a pathetic profession! It's a telling comment on the situation with medical costs that one of the most effective cost cutting measures would be killing off all the ambulance chasing scumbag lawyers who are just looking for their 50% cut of the settlement or jury awards. Then again, that would also cut the pool of future politicians by a really big percentage. Wait a minute, the idea is looking better and better. A win-win!

Paul: Tell that to the guy who had his wrong leg cut off!!!!

Gil-- that fella deserves to sue, and the doc deserves to pay. You have no idea how many times as a nurse I have pts ask "so do you think I could sue for this?" over things that are completely accidental/pts own fault etc.

Jackhmd, a lawsuit is considered a freedom of speech. I used to ask the same question as you are asking now. However, consult a lawyer or take a class in First Amendment Freedoms and you'll see it is how our court system views it. Basically, a fine would be seen as an deterence to people placing lawsuits unless they could afford to lose.

There's no simple solution out there. For every guy that had his wrong leg cut off, theres another person collecting a million dollar award for lost future wages because a dentist accidently hit a nerve and the dead beat patient once took auctioneer lessons.

Caps on medical tort don't mean you can't sue and get compensation. It just means the awards are ground in reality and the fact that, as bad as that patient's situation is because of a mistake, society shouldn't be paying for them to live it up. One of the most compelling arguements for high awards are the medical bills that patient (lost leg guy) will need to cover in the future. However, if we have a nationalized health care that covers everyone, is efficient, and really does keep costs in check (unlike the current one), then the only award due would be pain and suffering.

The courts address excessive verdicts with remittiturs. Look it up. Also, appellate courts can reverse jury awards that are inappropriate. Do some research. Most states have "loser pays" provisions in the law. Plus, no trial lawyer is going to invest the $75K-$100K or more into a medical malpractice lawsuit unless it has merit. Just because it's the other guy's loved one who was injured by a negligent doctor doesn't make it "frivolous." If the AMA and the health insurance companies would spend money on prevention of medical mistakes instead of lobbyists, we'd be a healthier country.

Floridagoddess, most states have loser pays court costs;not loser pays a fine for bringing a losing law suit. If I'm wrong, please direct me to the State that fines people for bringing a losing suit (and again, not frivilous, just a decent suit that loses - which is what that particular discussion was about). Sure there are ways of addressing inordinate awards. However, this is based on the sole discretion of a Judge who probably has zero understanding of the medical practice. Same problem that Intellectual Property suits involving Networking and Software face; people who don't even understand the subject matter making decisions as if they do. I like your last point however.

Isn't it in England where the courts can decide if the lawsuit is frivolous and based on taht it can be thrown out and you fined? also I think there is a fee to submit the suit in the first place? something like that would help in MANY situations in this country. We are too sue happy.

Loser pays court costs?! HAHAHAHAHAHAHAHAHAHAHAHAHAH

Ok, so, remind me, how many wealthy people bring frivolous malpractice lawsuits to court again? You know! The ones with enough assets and income to collect from in order to be reimbursed!

Oh yeah...somewhere between the range of next to nothing!

When you're a large insurance company with a large legal council on hand, how much do you think it must cost to mobilize these teams in order to combat the lawsuits that come your way?

It's ridiculously expensive! Plus, you can't stop the lawsuits from going to court, because we don't have a council to review the suit in advance, all it takes is for someone to lodge a complaint and file a lawsuit...that's it! The best someone can do is to try and get a summary judgment to make things end quickly...but often times, it may be easier to settle and not mobilize the legal team at all! Which is why so many parasitic lawyers make a living off of this!

A relative of mine who was a lawyer herself used to tell this joke:

What's the difference between a catfish and a lawyer?

One is a scum sucking bottom feeder and the other is a fish.

I've had to give depositions based on my own medical charts, and I can tell you that at least in my cases neither side really knew what the medical stuff meant. I was not on trial or being sued either time, though in one deposition the patient was there making statements as if to intimidate me (like I might be next if he did not win this case); but it was kind of amusing and sad at the same time to see that one side could perhaps have easily won over the other if they had only known what they were talking about.

We have to have lawyers to protect our rights as American citizens-our rights to a trial by jury of our peers, for one thing. Also, we need them for tax law, real estate law, child protection, and many other things.

@ seen too much,

Agreed, lawyers are indeed a necessary evil.

I think that the majority of the problem lies in the fact that laws today are extremely complex and more nuanced than they have to be.

I think that the US needs to have a council that follows the current legal precedence for most laws and modifies the language of the law into simple terms that reflects the new usage of that law.

This way, most loopholes large and small can be eliminated.

Remember, it's the nuances of the law that allow the most wealthy and powerful to circumvent them, or break them entirely.

I am sure that cutting down on unnecessary medical procedures would be the thing that would get medical costs under control. We could eliminate the cost problems. Insurance profits that Obama was blaming as the whole problem account for 1% of medical costs.

It's really not so much the act of having what may be considered 'unnecessary' imaging performed as it is a matter of where you have it done. The major issue, as far as imaging goes, is that a lot of people just assume they need to go to the hospital for that either b/c their attending physician recommended it (due to his association with the Hospital) or b/c their insurance doesn't have any requirements built in where specific benefits need to be handled by certain providers.

Sometimes basic like a CT scan could wind up costing thousands of dollars at a hospital (in terms of initial charges per scan) and meanwhile you could just go to a freestanding diagnostic imaging center like Quest and have the same images done for a fraction of the price by someone who likely has a lot more experience. Imagine reducing that overall cost on hundreds of thousands of cases?

The biggest costs for health care are Hospital system fees and medical insurance, the physicians themselves are actually on the dirty end of the stick when it comes to fee reimbursement related to office visits or anything that doesn't involve some kind of 'procedure' being performed. Unfortunately, the people who stand to gain from the aforementioned cost factors employ powerful lobbyist groups and that's why you didn't see either of those health care reform areas addressed in Obamas health care proposal.



Let me know when you got your MD degree and I'll take your word for it. Until than, if a change in what you "knew' or diagnosis was missed because the attending didn't verify it, I can bet my house you'd be one of those first folks to be at a lawyer's doorsteps the next morning.

Exactly Jon, and, even worse are the doctors who go overboard on extra testing and justify it because of malpractice risk. I had a friend who had an irritated esophagus, however, he had to endure a stay in the hospital and multiple tests for heart attacks. The reason was simple, the hospital had to due everything possible to rule out a heart attack in case they were sued in the event of a heart attack. It's ridiculous. Limits on malpractice torts protects both doctors and patients.

Okay genius-let me clarify, you were FORCED (at gunpoint, I presume) to sit in the ED? Cause we often do that-idiot! Number 2, if you knew what was wrong with you, why did you just refuse the test and leave? Number 3, if you already "knew" what was wrong with you-why were you in the ED-why not just go to your doctor in the am? IDIOT! See what we have to deal with America?

Limiting malpractice awards will, maybe, lower costs 2.5% while placing an undue burden on an innocent plaintiff. I was a tort reformer before I went to law school. Once you actually read the cases and understand how the system works you're less likely to be a tort reformer.

Sorry to ruin it for you armchair attorneys. Go back to watching Law & Order and getting legal advice from your favorite media outlet and leave real world law to the professionals.

And, no, I am not a personal injury attorney.

When Lawyers quit trying to practice medicine I'll listen to your dissertation on what other folks should do Yeah. Now, go back to watching your reruns of House and leave medical practice to the professionals instead of arm chair legal jockeys.

so doctors protect themselves by ordering extremely expensive test that the patient has to pay for.............................how easy is that?!..................and easy on the doctors pocket book.....the docs make all this money and then charge the patient for protection.

take two aspirin and call me in the morning..............and make an appointment to get an MRI.

Yeah, you are assuming a lot. I undestand the "undue burden on an innocent plaintiff". I also understand the undue burden on society to care for that innocent plaintiff. Is it right for a person to have to bear the repercussions of a doctors mistake? No. Does that mean it is right for me to pay for that doctor's mistake? also no. Tort reform doesn't mean preventing those who are injured from recieving compensation. It means limiting that compensation to commensurate amounts and cutting back on lawsuits from angry do gooders who think that they are hurting doctors and insurance companies when they are really just inflating the health care costs for all of us. And, how did you arrive at 2.5%? I may not reply quickly to your answer as I am probably absorbed in the current Law & Order rerun.

Soup, sorry you were inconvenienced; but I'm wondering why you would not have refused the test if you already knew what was wrong and it had nothing to do with why you were there. Unless maybe you weren't so sure at the time. ER doc's can be kind of nasty at times, though, I'll give you that. I once had to wait 6 hours for exactly...nothing. Just goodbye, call us if it gets worse. It wasn't until much later that I found out what was causing my symptoms. Another time I came in with a seizure witnessed by my husband, but they never did an EEG. If I've just had a test and know the results, however, I won't hesitate to tell them so they don't repeat it unless the nature of the emergency demands it. That's where not having an MD degree yourself is a problem, though.

What can tort reform accomplish? If it is done right it will still protect patients rights, but it will eliminate frivolous suits. The horrendous payouts from those lawsuits are a drop in a bucket in terms of healthcare costs. True. It will reduce defensive medicine. Savings from that are also a drop in a bucket in healthcare costs. I can't argue with that.....

But meaningful tort reform will lower the skyrocketing malpractice premiums that physicians pay. In the US we have roughly 700,000 practicing doctors, and if we reduce their malpractice premiums by 5K per year, on average (a very attainable goal), that is 3.5 billion dollars that can be used to cover the uninsured. Add to that the othe two "drops in a bucket" and you got yourself a good chunk of change that I would like to see go towards covering patients instead of pockets of scumbag lawyers and malpractice insurance companies.

And for those who are wondering, I am a physician and I do practice defensive medicine (to a degree)!

No doubt. If he really intended to make changes, he would have included it in the massive waste health care bill he rushed through.

At least he is doing something-better than the nothing that was done under Boob SR, Clinton, and Boob JR.

My best friend died at 40 due to medical malpractice. The doctor valued his patient's life at $250K, because that's all the coverage he had for his negligence. Doctors are the HIGHEST paid professionals in this country, and with that high income comes responsibilities. Why should they be more insulated from the consequences of their own negligence than any other profession in the USA?

Highest paid professionals??? I am a resident, I make $40,000 year at 80 hours per week, I'm $250,000 in medical school debt and I have friends from undergrad with buisness degress that are making 2x-3x what I will ever make as an attending doc.

floridagoddess, true negligence is rare, but it does happen. Nobody wants to deny compensation in the face of true screw-ups. But bad outcome DOES NOT equal negligence, or malpractice. However, there is absolutely nothing that can prevent anyone from bringing a lawsuit against a doctor, even if no wrong has been done - they might not win the suit, but by that time the doctor's name and reputation is dragged through mud. In addition, a lot of the time, the plaintiff and their lawyer are banking on malpractice insurance company's willingness to settle, because it would be cheaper to just pay some money upfront instead of trying to defend the physician, even if they will eventually win. And if they settle, then that doctor's name goes into a registry.

As far as physician's earnings you are sadly mistaken, so here is a little homework reading for you:

http://benbrownmd.wordpress.com/2010/06/20/informedconsent/

Well, if we don't find a job for Captain Obvious, he's going to just end up breaking into your car to fund his haroin addiction.

And we don't want that now would we?!...

...

...

The reason for the suits is insurance. Malpractice Insurance = Lawyer easy money fund. Doctors might officially pay the premiums, but they raise the fees you pay to cover the premiums.

Actually, insurance companies dictate what docs can charge. The physician has NO say in what they can bill a patient.

kbee

Dbakron is talking about Malpractice Insurance. Ask a physician what she/he pays each year. You might learn something.

Doctors have the luxury of knowing they'll get paid by insurance companies. How many people could afford what a doctor charges if there were no health insurance? If doctors would re-think their need to be millionaires, we could pay them reasonable rates and put insurance companies out of business. And, when you ask that doctor how much he/she pays for malpractice insurance, ask to see his/her personal tax return for the same year. I've known docs who pay themselves $95K/mo, and then get end-of-the year bonuses.

floridagoddess

Maybe you need to talk to doctors other than the plastic surgeons you use.

thanks for saying just what I was thinking.

Hanover Phist

thanks for saying just what I was thinking.

OMG! Kelcy, you're psychic!

but in all seriousness, yes, this is indeed a very big factor in the innumerable amounts paid out for fraudulent care from public coffers and insurance companies.

Just wait until they find out how many quack chyropractors there are collecting from medicare recipients, not to mention the fraud that many assist in perpetrating under workers comp and auto accident lawsuits

Doctors with medicare/medicaid patients have been known to do so because the government reimbusements are below costs. There was a doctor in Florida caught doing so in 2010.

Every doctor I have ever had wants to do tests - just to be sure - even the hospital ordered tests - just to elimate other possibilites.

Then there is the typical hospital with multiple units with doctors ordering overlapping tests. Not at Johns Hopkins. You get one doctor in charge of your case, and the only way a test is run is after a unit gets his/her approval first.

Kelcy, do some research. In a medical facility with a physician base larger than 10, aka hospitals, a physician cannot have a financial interest in an ancillary service. Violates the Stark Act. So that kind of throws your theory out the window. Nope, if you have ever worked in the medical profession, as a lot of the posters above, you know full well this article is a fact. They cover their butts. Nothing you wouldn't do in your profession if you knew every person that came in to your business was going to potentially sue you for just about anything. An if you are gullible enough to think this happens quite rarely...you definitely have never worked in the medical profession.

Kelcy: with all due respect, I am a physician, I dont have any financial interest in any equipment, and every day I order tests that my patients do not need because I am afraid of being suited. I live in fear of losing my home and my savings just before retired. I never had a complaint against me, but I saw what happened to mu colleges

Kelcy -

Why your nasty comments about doctors? And just your supposition, without much apparent knowledge.

As someone has already noted, the Stark law prevents doctors from referring to centers in which they have a financial interest.

Doctors are indeed sued, when the lawyer calculates he can make money in particular.

12% of doctors are faced with a new lawsuit each year. The numbers are higher for high-risk specialties such as neurosurgery and OB-GYN.

The average neurosurgeon faces a new lawsuit every 18 months. Would you like to face that on your job?

Most doctors are sued at least once in their professional lifetimes. So, as a doctor, you've either been sued, or are waiting for the trap to spring. Not a nice way to feel, and one thing that keeps many of our best people away from practicing medicine. One lawsuit can be the fly in an otherwise potentially desirable bowl of soup.

Again, this was a "duh" study, as someone has commented . It just restates what anyone practicing medicine for the last 40 years...or involved with tests, such as workers in radiology and diagnostic labs, knows.

"Studies" don't need to be done. Look at states where malpractice reform has been enacted...California, Colorado...and more recently Texas, where a recent law passage is attracting more doctors to the state. Obama refused to have tort reform as a part of his new, now unconstitutional, law, Abysmalcare. "Studies" proposed is nothing but a slick-talking delaying tactic. Speaking of slick-talking, did you know that John Edwards put over $30 million in his own pocket as his "share" of malpractice suits against OB-GYN doctors and hospitals in North Carolina? Not true of every plaintiff's malpractice lawyer, but a John Edwards type is often what a doctor faces.

Good theory but it is illegal for Doctors to have ownership in a lab or radiology unit which they could profit from.

Kelcy, Maybe you need to get your facts correct before you make statements like that. There is a law against doctors owning or having a financial interest in testing facilities (ancillary services). Doctors are not billing for the tests ordered and get no compensation for ordering tests. They are done at a hospital or laboratory and as mentioned above, the doctor has no financial interest in them and receives no compensation in any way.

Idiot! Can't happen-it's illegal! Docs cover their butts because of lawyers! Here in Florida the lawyers advertise on TV looking for any malpractice cases! What they are really saying is:
" I am a bottom feeder, I will take your case to screw your doctor and ruin him." For example, if you get lung cancer from smoking 12 packs a day for 45 years, "we will sue the doctor-after all he should have caught the cancer earlier."Nevermind personal responsibility, nevermind that the scumbag lawyer will get 50% of the settlement, nevermind you knew you would die from smoking!

I saw a lion licking his butt at the zoo the other day-my son asked the zookeeper why he was doing that? The zookeeper told my son that a lawyer had gotten too close to the bars, pulled into the lions cage, and eaten. The zookeeper said "the lion is just trying to get the taste out of his mouth."

fuuny chit duck.

I think much of HCR not having tort reform has to do with Harry Reid working hard from having any GOP input or bragging rights for something that is both reasonable and necessary! Reid was aching to abuse that super-majority as soon as the Left got it!

/Geez! It's amazing that that lunatic got re-elected! Those voters must be idiots!

But I guess CA re-elected Boxer, and she's awful! Though the GOP refused to support Campbell who was arguably the better candidate of any of the other nutters!

Man I hate politicians...they're all terrible!

Funny, the GAO says the bill will save money...kinda blows your statement "at a massive ecomnomic cost to america."

You must be a tea bagger-economic is the proper spelling, and America traditionally starts with a capital letter!

@Duckhntr12; the GAO said that the initial draft bill they had seen, which was INCOMPLETE at the time, would save money. They have come back since, after reviewing the completed law, and said that it woud NOT sdave money, because of the Democrats unreasonable assumptions built into the law.

Don't have to be a tea-bagger to recognize the truth. But it certainly helps not to be a Dem/Lib/Prog, who convinces himself that what he believes is true, no matter what the reality of the situation is.

Sorry, you're misinformed. Hardly EVER any punitive damages in a med mal case. Punitive damages are awarded only if there is malicious intent, not just negligent. Unfortunately, doctors are negligent every day, resulting in over 98,000 dead patients a year in the US.

Doc, I think that the trial lawyers say that lawsuits motivate MDs to provide better care -ie it does cause some "defensive" medicine, but that this is not necessarily bad. Having lived in a country that has essentially no malpractice liability for doctors -I tend to agree that this pressure is sometimes necessary to motive docs to do the right thing. -Of course there has to be a balance, and we in the US have a problem in the opposite extreme.

This study as reported by MSNBC is very flawed in that the doctors self reported that they were defensive. They did this knowing full well that the results of the study would be used to support or suppress tort reform. They would know that the more defensive medicine that they produced for the study, the stronger the case for tort reform. So you're right, no suprise here. Even if rampant defensive medicine exists most tort reform measures, like caps, are not likely to have an effect. Yes, Doctors don't want to be sued for a million dollars, but they don't want to be sued for $100,000 either. Caps will lower premiums -and as you say "help physicians with the cost of malpractice" insurance, but the impact to the overall cost to the system is not likely to be large.

As far as Obama is concerned, he believes that the courts are the best means for deciding these issues about how much someone should be compensated for medical error. I disagree with him, but I don't question his motives. He doesn't need trial lawyer support to get re-elected -he just needs an improving economy. Also it is not often reported, but several of Obama's closest friends are MDs. He regularly plays golf with a friend who is an internist, and a friend who is an obstetrician is so close to the first family that she often travels with the Obamas during their vacations. Also, Mrs Obama herself was a hospital administrator whose bottom line was affected by medical liability. So I don't think he's living in isolation to differing opinions on this issue.

Obama is a reasonable person in that he does listen to opposing opinions and he can be swayed by the arguments. Perhaps he's beginning to rethink this one. We'll see.

You have some good points. However, as a whole, physicians, especially obstetricians, do not like Obama. Trial lawyers, on the other hand, love the man. That's why the Trial lawyers association donated MILLIONS to his campaign. You don't see any physician group donating that kind of money to Obama or any other liberal democrat. I'm sure that money isn't for playing golf or going on vacation, but rather for Obama's surefire veto of any bill which would impose Tort reform. He and his wife are attorneys, and they will protect their kind far more than any physician's interest group. I'd like to see a national survey regarding defensive medicine practices of all physicians. They would speak the truth, that we ALL practice defensive medicine, usually on a daily basis. That's not bias or fudging a response for political reasons, it's a real issue we deal with every single day. The first thing a personal injury attorney asks in a deposition goes something like, "Doctor, is there any test which could be performed which would have diagnosed Mr. Smith's medical condition, and if so, why didn't you order it?" If the answer is yes, the next question from the attorney is "I like sports cars, and you good doctor just bought me a new Porsche. Should I get it in red or black?"

RDH -- just because the doctors were asked to self report doesn't mean they knew exactly WHAT the study was meant to find. For all the participating doctor's knew, it could have been a business model study being produced for a company planning on opening a chain of MRI/CT labs determining which types of physicians to target their marketing toward, such as those who more regularly perform "defensive" testing. It also could have been used by insurance providers to further decrease the reimbursement rates as a result of the "unneccessary" nature of a certain percentage of the tests.

The physicians were simply asked to check a box whether the test was "necessary" or "defensive"...what/why that data was being collected for was NOT shared with the physicians to prevent just the bias you imply. Again, the data could be used to support BOTH tort reform (which most of the docs would want so they might over-report, if known) or insurance reimbursement reductions (which most of the docs would NOT want so they might under-report, if known).

Some how I just don't think that's how the opening questions in a deposition actually go, but I'll defer to your expertise. As you know all malpractice cases are doctor driven. -Either by true neglegence on the part of the defendent or by differing opinions from opposing experts. It is the later that drives docs crazy. I can understand being fesisous about trail attornies, but you also have to put some blame on your own profession; those who ultimately do the dirty work -after all if a lawyer has a doctor who testifies under oath that it was malpractice, is it reasonable to expect him not to go with it?

BTW I know a lot of Docs and some don't like Obama, but most do like him and respect him -so I would take exception to the claim that physicians as a whole do not like him.

Unintended Consequences.

By doing this the Docs were test subjects, and thus would have had to have provided informed consent prior to participating in the study. Without such consent, the study would be in violation of the most basic of ethical principles for scientific investigation and thus would not be eligible for publication in any professional journal.

Why did they have to have a box on the form that said "defensive medicine?" If it were a true unbiased study, there would have been a blank where the doctor could have stated his reason for ordering the test, not some suggestion created by the group conducting the study. Garbage in, garbage out.

RDH -- Informed consent does NOT require that the final AIMS of the study be communicated to participants, only that any potential risks/complications as a result of a test/study OR the very fact that you are participating in a study AT ALL must be disclosed prior to participation. Otherwise, by your interpretation, someone in a drug study would HAVE to be notified whether they were receiving the new drug, an older drug, or a placebo, which destroyes the efficacy of the trial, especially for pain medication trials.

Perhaps the most well known example proving you are WRONG, RDH, is the Milgrim studies on authority. Participants were told they were participating in a study on the effects of increasing electrical "stimulation" on a person when the TRUE focus of the study was on the willingness to submit to authority. The outcome attempting to be proved DOES NOT have to be disclosed, especially when knowing the outcome in advance COULD potentially cause an effect on the very outcome trying to be determined. From a less scientific example proving you have NO concept of what "informed consent" means, a simple taste test, the hallmark of 80's advertising, would have been "unethical" because participants were not told in advance which beverages/foods they were being given, in which order. Clearly, you have NO background in testing procedures or ethics, so please leave your ignorance at the door.

florida -- first problem with the blank line option is trying to decipher what reason the doctor wrote...I mean seriously, have you seen their handwriting.... All joking aside, the blank line format would not have mattered since the other option was "necessary". If it wasn't necessary, then the most positive spin the testers could put on it was that the test was ordered for "defensive" reasons. What other reasons might the physicians have entered that would have had an impact on the study goal? "Just to inflict pain"? "Trying to make subject glow in the dark"? "Want to kill more trees with reams of test results I won't even glance at"? Perhaps they simply could have put "necessary" or "other", but the final analysis would have still been the same...only about 2/3 of tests are "necessary".

The people I know who entered into malpractice suits did so because of lawyers, not doctors; so I would consider them lawyer-driven. In one case (friends of ours, actually) the lawyer fed them all sorts of semi made up medical info to keep them in the case. The patient was supposedly in horrible pain all the time and in danger of paralysis but immediately after the suit was over, she magically felt much better. (We call that the "green poultice" in medical speak.) I was kept in the dark a good bit and honestly didn't realize what was going on until the patient was magically almost cured immediately after the lawsuit was settled.

Some of MY docs have volunteered to me that they do not like Pres. Obamas healthcare plan. (Ie, I didn't even mention it; they just told me, knowing that I am a PT. A family member who is a doc also does not like it.) They fear a huge shortage of docs in the future when kids in college now decide they do not want to practice medicine because it is impossible to make a living. Forget being a milionaire! I'm talking about making a living. Many of you don't seem to realize that the only paycheck a doctor gets at all is his profit. I've heard repeatedly that doctors should not be in it for profit-well, what are they supposed to live on? How are they supposed to eat? Do you work for a paycheck or salary or do you just do it out of the goodness of your heart? Docs often have at least 150,000 dollars of debt coming out of med school plus they may pay 100,000 dollars or more of malpractice per year. Imagine if you had to pay 100,000 dollars for something per year plus all your other bills. They have office overhead, staff, and living expenses. I'm tellling you that your idea that all docs are millionaires is unrealistic. Those exhorbitant bills you see don't all go to the doc. After your insurance reduces them to what they deem acceptible and does all their adjusting, the doc may only get a small percentage of that bill. My brother the doctor lives in a regular house in a regular neighborhood and drives an old car. I'm sure there are filthy rich doctors in certain fields-there always are. That doesn't mean all of them are.

Yes, agreed! Big Pharma is a big parasite on society. Besides all the diagnostic testing AND excess drugs, a huge problem is doctors consulting other doctors! Yes, they get all their friends and potential friends (all specialists) in on the case until there's a whole gang of doctors standing around the bed scratching their heads and writing out humongous charges. This practice must be stopped before the country is bankrupt! (This is also a defensive practice)

The color of grass depends on how you cure it.;-D

You don't know what the hell you're talking about. I gave nothing but praise to the doctors and the US medical treatment. I simply said there are inefficacy in the system. None are so blind as those who will not see. I'd bet you're a chronic complainer, not one to help to fix the problem. Maybe you have had too manyCT Scans. Don't you know that many of these tests bombard you with radiation?

Why don't you open you mind and try to change those things that create problems. There is generally no reason to repeat test that were just performed to look for something that was missed.Llook at the test that was just done to see if anything was missed.

As one of my practicing pulmonary specialists stated to me once..please don't ask me to order more tests, because we usually find something. Sometimes ignorance is bliss.

You have the right to refuse tests that are not necessary.

RDH..Oh, and you know each and every one of those? Wow. Why would you go to a doctor than?

Cole, I'm sorry but you don't have a clue what you are talking about. You get an advanced degree as an oncologist and I'll accept your opinion on what is necessary or redundant. Tests cost hospitals MONEY. Most are cost centers. Not profit. DRG's and Medicare denials make that a fact. There are rare fee for service ancillary services these days. So, that would be like you taking your car down for an oil change every day knowing full well it was a waste of money. It is ordered often to see the prognosis of treatments, or if changes have occured. Are there redundant tests due to lack of communication? Yes. Does the physician or hospital make money? No. It actually costs them money. That is what your Utiilization Committees are all about. weeding that waste out.

OMG, I can't believe you think doctors are making money from testing and the insurance companies are being taken advantage of! You obviously don't know how the medical system works. And if you are so concerned, you can refusse to have a test done that you just had done 2 days prior!

My issue with Cole, is why would he agree to testing that he thought was not necessary. He has to take responsiblity too.

Hospitals do make money for services provided. Yes, with Medicare there are limitations on payment based upon diagnoses, but private insurance companies usually do not have similar restrictions -they have restrictions, but hospitals do make more more for the additional services -UR just has to justify it to the 3rd party.

I an a family practice doctor and work in an office and not a hospital so I guess Quest Labs is making all the money on the tests I order and the hospital is making money on xrays. It certainly is not me or my practice.

Does it cost 10x more to provide those services and tests in the US? Yes. Come take a gander at the costs of just Maintenance contracts on the instruments and equipment that provide that testing. Radiology MRI and CT equipment runs into the millions for acquisition, with 100's of thousand's in maintenance costs. Yearly. Now look at the pay for qualified personnel to perform this testing. This is not an episode of "House" where the physicians do all their own testing. That is beyond a joke. Now look at the costs of plant maintenance, 24/7 nursing and ancillary personel. Clinical Scientists, respiratory, cardiology, 24/7 ER's, ICU's, CCU's. etc. Most of these are highly degreed folks. Now look at the cost of supplies for all of this testing and support... NO one. And I mean NO one gives hospitals free supplies. I spend on average $60,000 a WEEK in just blood products for transfusion services. That has nothing to do with the costs of reagents to perform the testing, the salaries of the Blood Bank scientists to perform those tests, QC on everything that moves, Proficiency Samples performed mandated by the Federal Government, inspections by the same folks...and that is just Blood Bank.

Your developing countries do not have these costs of operation. They have equipment often donated to them, and they often have voluntary personnel working the ancillary positions. Apples to Oranges basically.

I get zero.

If they participate in Medicare, then Strark Laws prevent the MD from receiving a commission for any test order. It's flat out illegal.

So, you were surprised to hear the answer "nothing"?

I get $0.00 for ordering tests, if fact, I have to spend longer hours at the office reviewing any and all tests I do order after a full day of treating patients, dealing with prescription denials, paperwork and phone calls.

Terry - I guess you were suprised to learn the doctor receives nothing!!

Depends on what is in the 2 or 3 percent. Is it just settlements or does it include lawyer fees, lost work time for clients and doctors, un-necessary tests,early retirements, etc. Hard to make much of any study's figures without reading where they came from.

Hmmm, atrial fibrillation...blood clots in the atria, then break off and travel to the lungs or brain...maybe Warfarin isn't such a bad idea after all.

Roll the dice Baby!

ENeal:

Love how you folks with your advance degree in medicine make such valid arguments on how a physician was wrong. If you had keeled over and died of a pulmonary embolism from the clot that wasn't treated by this physician, your family would be living in Monte Carlo right now.

See you after your stroke: A-fib doesn't spontaneouslydisappear never to return. Can'tt believethe idiots in the public sector. I sell my life to a pager 24/7, can be sued by some slob who smokes, drinks and eats crap years after his heart op. Glad to be retired and untouched by the bottom dwelling lawyers who live by other peoples misfortune, BTW if we cant replace your 92yo Moms aortic valve and have her out of the hospital running on the lawn its not our fault

So when you have that stroke r/t your years of untreated a. Fib you'll promise not to go back and sue that Cardiologist, right?

If you have recurring stones -on an annual basis, then you should get at least one CT for MRI.

I agree RHD but so far I have had 4 in two years. All the doctors say is that you have several stones. The next time I have to go they will do another one. I will light up and glow in the dark before they are through.

Doh....They got better equipment to treat you and you complain about the advances?? I am sure they gave you a diet to stick to to decrease the chances of recurrence and you basically blew that off. Didn't ya?

Jon Jones I am not complaining about the advances and I was not given a diet to blow off as you say. I was given a strainer and told to bring the stones to the lab.

The point I was making is that there has been a imaging centerr across the road for years but untill they got there own CT Scaner and MRI machines they never ordered any thing other than X-Rays.

Stones are made of different things and Diet alone does not always work. I have other medical problems that contribute also. My MD said I would just have to live with it. If you know how to fix the problem just let me know if you are a MD or Urologist sence I have been to both.

The issue you don't grasp, like most of the public RLK, is that all of this diagnostic testing costs a hospital a fortune in time, personnel, costs of that equipment, and the back-up of other ill folks in ED waiting on your bed. ER's are a drain on hospitals because a major % of patients are non-paying. So your thought that they bought these to make money in that setting are groundless. They bought them to be in compliance with Core measure treatment times mandated by your Federal Government. What you should have had done is a stone analysis. This will identify what its composition is. If your urologist deemed it isn't treatable by diet, there may be medication he/she can place you on to lower your recurrence rates, i.e. a cholesterol lowering statin or other for different compositions. A good urologist will identify this and treat if possible.