As for the Stark laws, I’m quite familiar with them — they (1) apply only to Medicare, not private insurance and (2) don’t apply to one physician referring to another physician in the same group practice (except where the latter physician “directs” the referral, which never happens formally, precisely because of the Stark laws). They similarly do not prohibit informal referral networks between physicians (e.g., the same informal referral networks that exist in every industry).

Have you not heard of Stark Laws against self referrals?

Also most ER docs are not employees. California is a fairly large state. and in fact, it is against the law for hospitals to employ physicians except for the VA and academic institutions. I think it is important for the patient for the doctor to have their interest in mind and not the employers.

I don’t think evidence-based guidelines would wholly remove all non-financial, non-liability (i.e., “simple diligence”) incentives to overtreat, though they would reduce them. There would be plenty of times when a physician understood what the guideline said but though, in their judgment, that more was needed to confirm, and so would order it anyway.

I will admit that I see this through the skewed eyes of an emergency physician. And while I can’t say never in the entire profession of emergency medicine is over treatment performed for profit, it is exceedingly rare. Most physician salary structures are not set up that way. But then you raise the question of “simple” diligence. The definition of adequate diligence is exactly the point of my argument.

I don’t know that it’s good or bad. It’s a mechanism for resolving a dispute about either the cause or the value of a harm caused. We will always need some mechanism for doing that.

If you want to adopt EBM as the standard of care, I’m all for it.

“OK, so it what you say is true then I know more than you and 99% of lawyers on med-mal court and general issues.”

If you’re a physician, you probably do know more about the details of the facts in most cases. About the procedure, evidence, etc. it’s doubtful.

Gosh, that sounds like an argument in favor of replacing the med-mal industry with evidence-based medicine. After all, it’s extremely unlikely that EBM would fail to recognize a fatal condition…

I disagree that liability concerns is the only motivator of ‘excessive’ care. Profit and simple diligence also create incentives towards over- rather than under- care.