WhiteCoat

A Nameless Faceless Killer

By BirdStrike M.D.

1) A 40-year-old female sees her family physician for burning chest pain after she eats hot peppers. She had it only once while exercising. Her family physician sends her to the emergency department and she gets admitted for chest pain. Rather than going home with treatment for her GERD, she ends up dead. This never should have happened, but the family never learns what really killed her.

2) A 33-year-old father of 3 dies on a hospice ward, bloated with steroids, on tube feeds with a tracheostomy. He was stricken down too young, his family is told, by a rare form of brain cancer. It was an unlucky fluke, they are told, but that is not the only reason.

3) A 7-year-old boy dies in the Pediatric ICU. His family is stunned, shocked and devastated. How could this have happened? The family is told he died from an ingrown toe-nail infection that spread to his blood stream and caused a severe form of sepsis. “It could happen to any of us.” They do not know that the breeding of this superbug was fed by a nameless killer.

4) A 16-year-old girl is on a CT scan table nervously giggling. Fifteen minutes later, she goes into cardiac arrest. A short time later, a solemn nurse informs her family that the patient has died from an allergic reaction. But her cause of death is something more insidious.

Each of these patients had a different doctor, but a similar contaminant. Much like a baseball slugger whose home run swing at a 100 mph fastball is thwarted when a camera flash from his biggest fan causes him to blink; the doctors were thrown off of their game. The culprit: Defensive Medicine.

In each case presented, the doctor had a very rational fear of being sued for either making a mistake or even for doing everything right. During the last moment in the rapid-fire decision-making process, each doctor had a “flash in the eye.” In each case, the result was a swing and a miss. Over and over, and over again in hospital wards, emergency departments, operating rooms, and doctors’ offices in America doctors are being told they must rule out every possibility or be sued. The ones who suffer are the patients, often tragically so. Why? Rather than trusting their instincts, the treating physicians are instead asking themselves, “What could a medical malpractice attorney possibly say I should have done?” While this may seem like a dangerous way to practice medicine, often the doctors have very little choice but to do so.  Consider the stories behind the cases presented above:

Case 1 – Susan, the 40-year-old stay-at-home mom, never wanted to go to the hospital. She just wanted something for her heartburn. Neither her family doctor, the emergency physician, nor the cardiologist really thought she was having a heart attack. In fact, they knew that a heart attack was an unlikely possibility. But an unlikely possibility still makes the heart attack possible. So each doctor, in succession, decided just not to take a chance. If Susan just happened to have a heart attack, the medical malpractice attorney could easily have persuaded a jury that Susan’s chest pain was misdiagnosed. To prevent such accusations, Susan went to the hospital, got admitted for “non-specific” EKG changes, had an “equivocal” stress test, and then had a coronary catheterization which perforated one of the arteries in her heart and killed her.

Diagnosis: Gastroesophageal Reflux Disease
Cause of Death: Defensive Medicine

Case 2 – Jack the 33-year-old dentist and father of three, fell and bumped his head when he was 13. He “felt a little funny” but he never lost consciousness. He had a normal neurologic exam. He had no confusion, nausea or vomiting. The ER doctor ordered a CT scan. The radiation damaged the DNA in Jack’s brain and 20 years later the mutated DNA developed into an untreatable glioma. Why did the doctor order the CT scan? He had a very rational fear of being sued. If Jack the 13-year-old was one of the small percentage of children who suffered bleeding inside the brain from his head injury, a medical malpractice attorney would easily be able to persuade a jury that the ER doctor was negligent for not performing a CT scan of Jack’s head. The ER doctor was told he should not practice medicine out of fear, but he had a colleague that was viciously attacked in a medical malpractice case where he did everything he was supposed to do, yet his colleague lost a multimillion dollar judgment. The doctor was afraid.

Diagnosis: Stage IV glioma
Cause of death:
Defensive Medicine

Case 3 – Billy the 7-year-old boy had sore throat. His doctor checked him for strep. The screen and culture were negative. Just at that moment, the doctor hesitates. He remembers a colleague and friend who did not give antibiotics to a young girl with a sore throat and a negative strep test. The girl was one of a few patients who develop strep despite a negative screen. The patient’s pharyngitis worsened and she developed post-strep rheumatic fever. She had rare and terrible complications. Her doctor had done everything right, but there was a long and painful lawsuit. The lawyers argued that if he suspected strep he should have started antibiotics. Shockingly, and unjustly, this doctor lost the case. The little girl’s outcome was just so sad and unfortunate that the jury felt they “had to give the family something.” He recalls that his doctor friend was left financially and emotionally devastated.  Billy’s doctor decides not to risk the same fate and prescribes Billy an antibiotic.  The antibiotic does nothing for Billy’s viral pharyngitis, but it does kill off his healthy bacterial flora and allows overgrowth of antibiotic resistant organisms, which infect his ingrown toe nail, causing cellulitis, bacteremia, sepsis, and death.

Diagnosis: Sepsis due to multiple drug-resistant organisms
Cause of death: Defensive Medicine

Case 4 – Julie the 16-year-old cheerleader died from an anaphylactic reaction to CT contrast, from a CT scan she didn’t need. From his clinical experience treating thousands of patients, the doctor knew in his gut that Julie didn’t have appendicitis. He knew that her elevated WBC count and increase in bands doesn’t always mean there is a serious bacterial infection, because he’s seen hundreds of patients with similar presentations whose pain goes away the following day. Everything else about Julie screamed, “No appendicitis!” The doctor was using his clinical judgment as he was taught to do. But he second guessed himself and thought, “A jury of non-medical people would never understand that.” So the doctor ordered the CT scan so that he would be able to defend himself if he was later sued. The voice in his head tells him, “I know she doesn’t have appendicitis, but with a white count of 14? Right lower quadrant pain? The lawyers would have a field day with that.” Like one of Pavlov’s dogs, he did what he was trained to do, not by his physician teachers, not by his medical textbooks, but by lawsuit verdicts.

Diagnosis: Enteritis and anaphylactic reaction to intravenous dye
Cause of death: Defensive Medicine

None of the death certificates in these cases list “Fear of Being Sued” as the cause of death. Yet in each case, defensive medicine was a contributing cause to the patient’s deaths. The effect of our medical tort system has upon doctors’ thought processes afflicts patients like any other disease. Defensive medicine doesn’t just cost our society a lot of money. It can also cost our patients their lives. However, the adverse clinical effects of defensive medicine often go unnoticed or unreported. They are not tracked by the CDC. They do not generate the heart wrenching sympathy and funding to fight “Breast Cancer” or “AIDS”. If anything, the media encourages doctors to practice defensive medicine by publishing stories about patients with obscure presentations of diseases who die because doctors “just didn’t do enough.”

Attorneys may argue that “defensive medicine” is irrelevant, that it is good for patients, or that it is proof that our legal system pressures doctors to be more “careful”. Apparently, some doctors seem to agree. Dr. Sanjay Gupta wrote an editorial very recently seeming to imply that, that doctors just need to “be reminded that more is not always better,” as if doctors can and should simply swat away thoughts of lawsuit avoidance like an annoying fly on their shoulder. Dr. Gupta’s article appears to imply that doctors are at fault for trying to avoid lawsuits and that doctors are violating their oath to “do no harm” by ordering more tests to avoid lawsuits. His logic is tragically wrong.

Most laypeople just don’t know what it’s like to get sued for simply doing their job (let alone making a mistake) or how much a constant threat of being sued will change one’s behavior. The average grocery bagger doesn’t have to contemplate a year’s long trial and eventual 6 million dollar lawsuit if they bag a customer’s eggs on the bottom of the bag. I am certain that if they did, they would change their grocery-bagging practice patterns in a way that no lecture from their store manager could reverse. A school teacher does not have to obsess about spending years in court, with his name and reputation on the line for a lesson plan that had an unexpectedly poor outcome. If they did, they would certainly alter their teaching practices to avoid being sued again.

Most laypeople also do not appreciate how pervasive, omnipresent and ingrained lawsuit avoidance has become in the mind of the American physician. Doctors are expected to be “more careful” when they are in doubt, because if they do less, and a bad outcome occurs, they may be legally liable. Few family members ask if a doctor did “too much” after a family member has died during medical treatment.

As long as “defensive medicine” and “tort reform” remain a tug-of-war between doctors and lawyers, patients will continue having adverse consequences and no meaningful change will occur. Doctors will always feel there are being persecuted for “just doing their job” and feel forced to protect themselves legally in the only ways they know how … by doing “more”. Attorneys will likely always feel that the cases they are pursuing all represent the negligence of dangerous doctors who didn’t do enough. This tug of war is tired, old and unproductive.

Our medical malpractice system has clouded the judgment of many physicians and it needs to be fixed for the health of our patients. When we encourage doctors to just “snap out of it” and “stop worrying about being sued” how should we instruct them to avoid being sued for multiple millions of dollars? Until the answer to this question involves something other than “defensive medicine,” over-testing, overtreatment, and overmedication will persist and the cause of death on many death certificates will continue to be inaccurate.

 ———————————————————————————————————————————————-

This author does not divulge protected patient information.  Any post that appears to resemble a real patient is by coincidence.  This author does not post, has not posted and will not post about real patients.  Although these posts may be inspired by the author’s experiences, they are not about real patients, because that would violate patient confidentiality.  If you would like to have a patient story published on WhiteCoat’s Call Room, please e-mail WhiteCoat.

 

18 Responses to “A Nameless Faceless Killer”

  1. Excellent post, WhiteCoat.

    The solution? Institute the English Rule, sometimes known as “loser pays.” If the plaintiff loses the lawsuit, he pays the defendant’s legal fees. Plaintiffs and their lawyers would think long and hard before pulling that trigger.

    -Steve

  2. Matt says:

    ” Over and over, and over again in hospital wards, emergency departments, operating rooms, and doctors’ offices in America doctors are being told they must rule out every possibility or be sued. ”

    This is simply not true. It’s not even close to being true. There is no evidence it is true, and never has been.

    “Most laypeople just don’t know what it’s like to get sued for simply doing their job (let alone making a mistake) or how much a constant threat of being sued will change one’s behavior.”

    This is also incorrect. You aren’t under the “constant” threat of being sued any more than every architect designing a building, every semi-truck driver on the highway, etc. Yes, the grocery bagger doesn’t worry about being sued, but then he isn’t paid what you’re paid nor taking on the level of responsibility you are. That’s a pretty inept comparison.

    “Attorneys will likely always feel that the cases they are pursuing all represent the negligence of dangerous doctors who didn’t do enough.”

    This is also untrue. There are those physicians who are simply dangerous, and even other physicians know who they are even if they do little to expose them. But most attorneys know that negligence is sometimes simply a mistake. Just like sometimes a person runs a red light without even realizing it. It doesn’t mean they’re terrible people, they just made a mistake. That mistake results in damages though, and those have to be paid. And if the insurer and the injured person can’t agree on the amount or the liability, that’s why we have juries. It’s not because the person who caused the injuries is a bad person, but because sometimes mistakes, innocent or not, are simply made.

    “As long as “defensive medicine” and “tort reform” remain a tug-of-war between doctors and lawyers,”

    But it’s not. It’s a tug of war between insurers and injured people. Doctors almost never pay claims out of their own pocket. Lawyers have no claims without injured parties. That’s who is fighting. The physicians have chosen to become the face of the insurance industry, but they do not have to do so.

    As for Dr. Parker’s proposal for loser pays, it’s pointless. First, it doesn’t work like he probably believes it does in England. Second, many states already have a version of it. Third, the cost of pursuing a malpractice suit already causes most people to think long and hard about it.

    You’re right that it is a tired debate. And why? Because your solutions are simply the same ones that after 40 years have not shown themselves to reduce the defensive medicine you complain of. You crow about Texas as the “model” for reform, yet healthcare is no cheaper in Texas. Physicians aren’t performing FEWER tests in Texas now.

    http://www.newyorker.com/reporting/2009/06/01/090601fa_fact_gawande?currentPage=all

    But it is time to start this debate again. If only because insurers have suffered some state court setbacks in their attempts to keep those people injured the worst from negligence from recovering the full measure of their damages. By the end of this year, middle of next, we’re going to have “crisis” maps again, sad tales of woe about malpractice costs to physicians (we always hear their expenses, but strangely never their income), and how this or that insurer in one particular year or couple of years lost money, irrespective of their internal financial management or their decades long profit margin.

    What we can be sure of though is at the end of the day, there won’t be a reduction in “defensive medicine” (however defined), healthcare won’t be any cheaper, malpractice insurance will rise and fall with the investment climate, and there will still be malpractice as no significant changes to the true causes of malpractice will be made.

  3. Matt says:

    ” Until the answer to this question involves something other than “defensive medicine,” over-testing, overtreatment, and overmedication will persist and the cause of death on many death certificates will continue to be inaccurate.”

    And the histrionics begin. It’s really weird to see a physician say this, because often they quite correctly note that sometimes people just die. It’s their time. No one is to blame. Yet here is a physician using the nebulous term “defensive medicine” as the reason. Furthering the blame culture they claim to detest.

    Overtesting, overtreatment, and overmedication aren’t going to change as long as the consumer is not the payor. That’s just a fact. Us consumers are marketed the latest drugs as wonder cures every day. Hospitals and physicians market the latest technology and treatment to us every day. You want us to use them, and we have no incentive to say no since we don’t pay for them directly.

  4. igloodoc says:

    Yes Matt, we go round and round. You continue to dismiss the fact that defensive medicine exists. I sincerely doubt that we can convince you differently. As long as your profession believes we can sue our way to good health, and the public believes we can legislate our way to good health, the system will ultimately collapse.

    I guess the US just churns out “bad doctors”. (yet, oddly enough, there are almost no “bad lawyers”). More “bad doctors” than other countries. And it is good to see “most attorneys know that negligence is sometimes simply a mistake”. If you accept that line of reasoning, then doctors and nurses are not allowed to make “mistakes”… it’s negligent to make mistakes. Perfection is the norm. Make a “mistake” and your malpractice premiums go up, and the scarlet letter of “Please list any lawsuits for the past 10 years. You may want your attorney to complete this section” will follow you from job to job, wherever you go. And you will be registered on the National Bad Doctor Database (yet there is no National Bad Lawyer database… I guess with all the good lawyers around we just don’t need one)

    Or, could it be that the legal community, maybe in response to the insurance companies, has created an industry out of malpractice? Look at a comparison of a judicial hellhole like Florida to the Canadian judicial system.

    You will dismiss any semblance the Canadian system occurring here, or valid comparison. But thanks to the ACA (Obamacare) we have the first step to a single payer system. And a single payer system HAS to come to an agreement with its doctors. Wonder how that will impact the trial lawyers…

    • Matt says:

      “You continue to dismiss the fact that defensive medicine exists.”

      Actually, I don’t. I don’t believe it’s that easily definable – after all one docs “defensive medicine” is another’s “necessary” test. But let’s say I’m fully on board with everything you call defensive medicine. What next? What are your proposals? Well, the truth is you don’t really have any, your insurer does, and it’s damage caps. The thing is we’ve tried those. For decades. And there is literally ZERO evidence they do any of the things you claim they’ll do. They don’t make healthcare cheaper, they don’t improve the practice climate, and you don’t order any fewer tests.

      “As long as your profession believes we can sue our way to good health, and the public believes we can legislate our way to good health, the system will ultimately collapse.”

      Of course, my “profession” believes no such thing. And the public doesn’t either. But what do you physicians believe? We see what your insurers believe and that you sign on to, but that doesn’t really address your issues. Where is the proposal of physicians? Where’s YOUR legislative proposals? Your biggest lobbying organization thinks Obamacare will get us there. So is that it?

      ” Perfection is the norm.”

      You keep saying this, but there is literally ZERO objective evidence of it. The reality is most malpractice never sees a claim file. And juries generally side with you. So who is requiring “perfection”?

      You try and compare to other countries, but you really don’t know how those physicians are disciplined. And I don’t think you read what I said – you’re not a “bad doctor” if you make a mistake. You’re just someone who made a mistake. But that doesn’t mean you don’t have to pay for the consequences.

      And lots of lawyers get sued. And you can look up most disciplinary actions via the State Supreme Court’s website. No, there isn’t a national database, but we haven’t quite sold our economic souls to the US govt. like physicians have.

      There is no “malpractice industry”, even in the loosest definition. There are lawyers who specialize in that, just like there are physicians who specialize in certain areas. There’s something to be said for a depth of knowledge.

      You want the Canadian judicial system, go practice medicine in Canada. I totally agree with your last paragraph. And how will it impact “trial lawyers”? (Who is that? Any lawyer who tries a case?) It won’t impact them much, because if they’re good, and most attorneys who specialize in med mal on both sides are very good, there will always be well paying work for them.

      • igloodoc says:

        “You continue to dismiss the fact that defensive medicine exists.”
        “Actually, I don’t. I don’t believe it’s that easily definable – after all one docs “defensive medicine” is another’s “necessary” test. ” This defines what defensive medicine is. I do tests to prove a normal. Of course the expert you are hiring will tell you the test is necessary, just as the expert I hire says it is not. Good system. No independent opinion, just hired guns. So, defensive medicine is just geared to anticipating what your paid expert will say was needed. Note the patient is absent, and the things described in the article happen.

        “As long as your profession believes we can sue our way to good health, and the public believes we can legislate our way to good health, the system will ultimately collapse.”
        “Of course, my “profession” believes no such thing. And the public doesn’t either.” If it please the court, I would like to enter the following into evidence. EMTALA. HIPPA. Affordable Health Act. Stark Law. No, your right. We are not legislating and, as a result, suing our way into good care. Really?

        ” Perfection is the norm.”
        “You keep saying this, but there is literally ZERO objective evidence of it.” Actually, Matt, this was your implication, equating a mistake to negligence. Negligence implies malice, mistakes have no malice. When you state “But most attorneys know that negligence is sometimes simply a mistake” you equate the two. Fortunately, juries realize the difference, at least for now.

        “You want the Canadian judicial system, go practice medicine in Canada.” Actually Matt, i do practice both here and in Canada. I am aware of the physician training, discipline procedures(not personally, don’t worry) and legal climates of both countries.
        And I do have specific proposals on how to change the system, and caps are only a small, partial solution. They certainly won’t work here in isolation the US. But the solutions I would propose, you would not like at all. For starters, lets federalize the malpractice system under federal tort, make malpractice a unanimous jury verdict, instead of a preponderance of evidence criteria now used. All cases should go to independent, unpaid review before being allowed to be filed. Punitive damages are allowed only if there is criminal malice, otherwise are banned. I have other suggestions that you won’t like, if you are interested.
        As to malpractice climate, wherever I work in the US there is a palpable fear of malpractice suits. It permeates the care and practice of physicians. The same cannot be said in Canada, because there is no lawsuit industry like here. The Canadian system has its own problems, but a lawsuit industry is not one of them.

  5. Matt says:

    Igloo,

    1. Most of the state you cite have the support of your lobbyists.

    2. Negligence does not require malice. Never has. If you didn’t know that until now I understand why you were so fired up. But malice is not an element of proof to show negligence.

    3. I have no doubt “fear” of lawsuits is a problem. But should we pass laws based on fear, regardless of rationality?

    4. Punitive damages are so rare in med mal as to be nonexistent.

    5. Why do you want to federalize everything? No appreciation for principles of federalism or the Constitution?

    6. Your proposals aren’t bad but you know who really won’t like them? Insurers. If there was a free, quick access to truly independent review the volume of claims would explode. Right now a lot of low damage malpractice never gets paid as its too expensive to pursue. And even high dollar malpractice often doesn’t go anywhere. You change that and the insirerws will be paying more than ever.

    Of course you may be wanting to go to single payer which renders this all moot. What is the “lawsuit industry”?

    • igloodoc says:

      “Negligence does not require malice”. My bad. In the non-legal world there is association. Negligence is thought more in terms of carelessness (malignant) than simple mistakes (benign). Legally, you are quite correct.

      “Most of the state you cite have the support of your lobbyists”. Actually it is personal observation. Can you tell me who my “lobbyists” are? (and don’t say the AMA – they represent academics and students. ACEP and other groups are too busy eyeballing their own sphincters to be effective lobbyists). I do agree, Matt, that my profession has invited the abuse, and now it’s time to suffer the abuse. We should have hired the ATA to lobby for us.

      “But should we pass laws based on fear, regardless of rationality” So much for the argument against legislating our way to good health. I have outlined a couple of steps to alleviate the fear. Because, as the article shows, fear is killing people.

      “Why do you want to federalize everything?” .. to insure uniform standards are applied, and we don’t end up with the judicial hellholes like Florida. That whole environment is just toxic. And, federalization will come anyway, it’s a matter of time (regardless of single payer).

      “you know who really won’t like them? Insurers.” Maybe. Granted, the next logical step of federalization is to federalize malpractice insurance. And when the malpractice lawyers go after the government, the government will pass legislation like Feres doctrine in response. Deems ridiculous

      • igloodoc says:

        Last sentence should be:
        Seems ridiculous, but do you think the Canadian malpractice system came about by accident?

      • Matt says:

        ” (and don’t say the AMA – they represent academics and students.”

        If the AMA is not the primary physician lobbyists, then they have an excellent marketing department because if you ran a poll I bet you’d find the public thinks otherwise. Isn’t the AMA chiefly responsible for setting reimbursement rates of Medicare through a committee with some unwieldy name?

        ” Because, as the article shows, fear is killing people.”

        Actually, the article doesn’t show that at all. It makes a number of assumptions, and I’m surprised to see you make such leaps, although I expect confirmation bias explains much of it.

        ” to insure uniform standards are applied, and we don’t end up with the judicial hellholes like Florida.”

        How does one determine a “judicial hellhole”? Sounds like a lobbyist term, rather than anything with a particular meaning. I agree with you that federalization is coming, but the conservative in me is in no hurry to further reduce the rights of individuals.

        And you’re absolutely right about next steps. I’ve said many times, malpractice will soon be governed by some byzantine regulatory process to both compensate victims and punish physicians. No one will like it.

  6. emdocmd says:

    To give you an example of BS lawsuit, Matt…one of my colleagues is undergoing a lawsuit for defensive medicine. Initially, the patient could not find any ‘decent’ lawyer to take his case, because no other lawyer thought he had a case. However, there are 600+ law students grads a year in my home state, and most of them can’t get jobs. It actually wasn’t hard for him to find some lawyer who was willing to work the case because didn’t have anything else to do. It has been on ongoing process, over the course of a years, causing undue stress to this excellent physician. What is going to happen? They are going to settle to finally end it. The other option is going to jury of “peers”, and god only knows how that will end up. Matt, you simply state that everything Birdstrike says is simply not true, when in fact it is. Its not hard to find an unemployed lawyer who is looking for a break.

    • Matt says:

      I love anecdotes. They’re almost evidence. But they’re not. If you’re going to file bogus cases, you file car wreck suits. Not cases where the jury sides with the physician the vast majority of the time, and that cost you tens of thousands of dollars to pursue.

      And unless you’re sitting in the office with the patient, you have no idea how many other lawyers they saw or what they were told.

      And spare me the “insurers going to settle because they’re scared of a jury” line. It’s particularly strange to hear that nonsense out of a physician. Your profession Should know better than any how hard it is to squeeze money out of insurance companies. Why you think liability carriers are different than any others is beyond me.

      But let’s assume you are right. Where can I find your solution?

      And I didn’t say everything was not true. I said some of it was. I agree with igloo that single payer renders this all moot. Hope that works out for you physicians though.

  7. DdR says:

    This is exactly why a doctor should be tried by a jury of his PEERS – i.e. the jury should be comprised only of medical practitioners (though not limited to doctors).

  8. Starjack says:

    A few years ago I was having some minor health problems. The doctor tested me for anemia even though I had none of the symptoms because it was a possibility. It was just a finger stick, and it really didn’t do me any harm, but it’s symptomatic of a larger problem. I’ll bet people get unnecessary tests all the time and don’t realize it’s defensive medicine.

  9. Max Kennerly says:

    The “examples” are so unscientific they might well have been posted on an antivaccination site. #2, for example, shows a basic failure to understand how radiation causes cancer through cumulative exposes; under your reasoning, everyone who ever flew on a transcontinental flight would die from cancer within a decade or two. #3 is hilariously wrong, like something from a St. John’s Wort ad advising people not to take antibiotics.

    But #4 is the best: you’re arguing no less than “CTs should be banned from medicine.” That’s the only way to interpret that example. Is that really what you think?

    • BirdStrike says:

      The examples in the article were simplified for illustrative purposes. They were not meant to be a treatise on how radiation causes cancer, or on how the over-prescribing of antibiotics selects for resistant organisms. Those have already been written.

      The above comments are the exact “tug of war” that I describe in the article, which does nothing but distract from the issue, very conveniently so. Such are attempts to shift the discussion away from the effect of defensive medicine on patient health and towards “costs” and other issues. Another is the argument that since in states where tort reform has been enacted health-care costs and medical testing have not decreased sufficiently, therefore defensive medicine was never really a problem and tort reform was never really needed. This is a fallacy and proves nothing more than the fact that the tort reforms in such states were not strong enough. We all know where physicians and attorneys stand on the issue. What is most important is what patients think about the issue.

      You can mock the examples, you can mock the article, and you can twist and spin the data in whatever way you want. However, physicians are saying and writing over and over again, in print, online, on TV, in private and in scientifically performed surveys that they practice defensive medicine, that they see colleagues practicing defensive medicine, and believe that it is bad for patients.

      What it really comes down to is this: you can either choose to believe them, or not. If you think physicians are simply lying about the issue for self-serving reasons, okay, that is one view point. Make that argument. Otherwise, if you prefer a more “scientific” explanation, I would refer you to the Archives of Internal Medicine: “Physicians’ Views on Defensive Medicine: A National Survey Arch Intern Med. 2010;170(12):1081-1083″

      http://archinte.jamanetwork.com/article.aspx?articleid=416067

      • Matt says:

        “which does nothing but distract from the issue, very conveniently so.”

        Except “defensive medicine” is not the issue. The whole “defensive medicine” claim exists solely as a creation of insurers trying to reduce their risk.

        You say the “tort reform” was not strong enough, but the only tort reform seriously proposed is “reform” designed to either a) make it more difficult to file a claim by making it more expensive; and b) designed to keep people who are found to have a legitimate claim from receiving the full measure of damages.

        There is no movement to reduce costs. Why? Because tort reform as an issue arises from corporate America trying to reduce its exposure to individual claims and class actions. Not improve medicine or save money on healthcare. That’s why all the legislative proposals, when you read them, are only guaranteed to benefit insurers. The proponents promise ancillary benefits to physicians and patients, but despite decades of these promises they have never materialized.

        Physicians have told us in the recent past there was too much defensive medicine and thus we needed tort reform. Some states passed it. Yet healthcare hasn’t improved or gotten cheaper in those states.

        Citing us to surveys of physicians doesn’t tell us much other than what they believe. They’re not lying, per se, I’m sure they do believe it. The truth is, though, they really can’t agree what is or is not defensive medicine when applied to particular patients or procedures. You’re “defensive medicine” is another physician’s necessary and proper test. But even assuming we could define it accurately, and assuming it wasn’t just a lobbying phrase, you have literally proposed nothing to curb it.

        Now you’re telling us we need more of the same things that haven’t worked in the past? You sound like the President telling us the stimulus will get unemployment below 6%, and when it doesn’t do anything, saying we just needed a little more.

        And I’m sure you’ll say “well, the insurers proposals aren’t what I want to do.” But what you want to do never gets proposed as legislation – what THEY want does. Because they put their money where their mouths are. And their money doesn’t go to support individual, Constitutional rights.

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