This is a story from the other testing extreme. I had a patient who fell, and hurt her neck. Fell off the porch of a local charity. Their liabilty insurance will pay for the fall 100% , but not for routine care. Late 70′s with diabetes , hep C from an MVA related transfusion, hypertension, high cholesterol, good labs and BP . Brought to her friends favorite neurosurgeon in another town (the one here is a jerk, and she wasn’t going back after I sent her) .Pain getting better, she stops coming in for this after 2 visits, cancels one of her q 3 month regular visits.

Anesthesiologist, blesss his heart called me with questions one day pre-op . I had no clue surgery was scheduled .No pre-op eval done except by a wellmeaning neurosurgical PA. No tests, just the required H and P . Day of surgery , in Afib, not known to have this, referred , not to me, to a cardiologist who says “she has chronic heart failure from valve disease” , EF is 20%. Too bad he did not see the 3 years ago EF of 58% with no valve disease, even though he requested the records (another issue there ) . Now this is my fault per family and neurosurgeon, who I have yet to meet , speak to, or see any recods from …..yet another issue . Ultimately the cardiologist said surgery was OK, not knowing her neck and arm symptoms were almost all gone. Her neurosurgery visits were being driven by the fact someone else was going to pay for surgery.
Hope someone , since she fired me, eventually looks to see if she had a big silent MI with annular dilatation , not that she is surgical candidate any more.

The appropriate test was an H and P with her PCP. That made no money for the other hospital’s lab, and perhaps the PA’s fees for the H and P go to the neurosurgeon. Unclear.
So who suffered? The poor patient.

““Right now, plaintiffs only look at the “upside” of what could happen if they win since there is no “downside.””

You can also refer to the 2006 NEJM study by Dr. David Studdert and others, which is probably the most comprehensive study of malpractice litigation ever, wherein the study notes:

“The profile of non-error claims we observed does not square with the notion of opportunistic trial lawyers pursuing questionable lawsuits in circumstances in which their chances of winning are reasonable and prospective returns in the event of a win are high. Rather, our findings underscore how difficult it may be for plaintiffs and their attorneys to discern what has happened before the initiation of a claim and the acquisition of knowledge that comes from the investigations, consultation with experts, and sharing of information that litigation triggers.”

http://content.nejm.org/cgi/content/full/354/19/2024

If you believe this, you are not listening to the President. The cost of care is going to be shifted to ALL taxpayers, not the individual patient. While you’re pussyfooting with legal matters, the freight train of universal care is going to run you over. And you, the medical professional who deals with it day in and day out, are going to be the one most impacted. And likely not in a positive way, unless you have an unhealthy love of bureaucracy.

You’re not going to catch flack from me being against some of the advertising. I am too. I would never argue there are not excesses that could be curbed. My position is that allowing lobbyists to arbitrarily decide the value of an injury without hearing the evidence or regardless of fault is simply the wrong way to do it. You’re just hurting the weakest among us to save insurers a few dollars. That is where I and the good doctor get sideways.

By the way, what does “legal professional” mean? I’m guessing it doesn’t mean lawyer.

There really is no argument that medicine is a litigious area, however the question is what is reasonable? In medicine there are incompetent, careless doctors, nurses, PA’s, techs, etc., and there always will be. Is it reasonable to sue a physician for not being able to foresee a patient having a heart attack 10 days post from having a mole removed? Speaking reasonably, having no history or current indication of such, the answer is no. is it reasonable to sue a doctor for amputating a limb when a mole was supposed to be removed? I would think yes. Much of the current medical litigation is fueled by the legal community. I have been home mending for the last 10 weeks and the number of commercials for attorneys on daytime tv is astounding. Side effects from medication, an unexpected outcome from a medical procedure, not happy about the wait at your doctor’s office? SUE! The attorney’s who are paying for these commercials are more than likely far more educated than their target clients and let’s face it, if someone is home and awake during the day watching tv, it is more likely than not that they are unemployed and less educated (unless of course, one has broken their fibula). I suspect there will be some some flack from Matt, but let me remind that I am a legal professional and still agree with the medical community.

Now, for skin. My skin is so far in the game, it’s being sloughed off. I pay full freight for my medical insurance and let me say the coverage is less than stellar. WC is correct in the idea of a P&L on the part of patients. Currently I pay a monthly premium for my insurance in addition to the co-pays and all the procedures and equipment the insurance company doesnt cover AND I pay into medicare. Medical coverage isnt free, someone is always paying and wouldnt it be nice if patients thought beyond themselves and consider the impact on those that are paying. WC’s mom isnt receiving services she paid for, she is receiving services current taxpayers paid for. The issue is systemic and though the idea was good, the implementation of Medicare is flawed.

My father is a life long smoker; 50 years of smoking 2+ packs a day. His medical bills far exceed what he has paid into Medicare and his private insurance combined for HIS LIFETIME. When I see someone casually smoking it infuriates me that I, at some point will be paying for their ridiculous, notoriously bad behavior. My insurance premiums continue to increase year over year, while my coverage declines due to little if any fault of my own as a relatively healthy 34yo female who makes a conscious effort to sustain good health.

As previously mentioned, I recently broke my right fibula, chipped the talus bone and tore the deltoid ligaments. Hospitalized for 3 days, surgery, hardware, the whole deal. The insurance company declined the claim. After faithfully paying, the 30k bill was denied and I was saddled with the bill, only after much grief and strife was the bill partially covered by insurance. The accident, through no fault of my own was denied when I was responsible and procured coverage specifically for something of this nature.

I do question the number of xrays prescribed and the number of PT visits (seems a little low), because I know come January, my premium is going up, it is just a matter of how much. My scripts are filled generically if possible because I pay the difference between generic and brand names. What the hell do I care if the script is Percocet or Roxcet? Just kill the damn pain. Patients should be given an itemized bill for all procedures and visits whether covered privately, or publicly. $1800 for a stainless steel plate and 7 screws?? The anesthesiologist charged the same, now which one is inflated?