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A comment on Malpractice Laws Face Changes and Debate

Mike — Tue, 01 May 2007 16:35:58 GMT

Defensive medicine is a NEGATIVE phrase, NOT a POSITIVE!!! Don't you get that?? You don't want that!! It leads to overdiagnosis. It leads to errant diagnoses. It leads to tests that are unnecessary and potentially dangerous!! Society can't afford defensive medicine. Its not a myth, you lawyers!! Cost analyses are done all the time in journals, that have NOTHING TO DO with the insurance companies. Should every smoker get a chest CT?? Why bother doing studies...LETS JUST ORDER THEM according to your dumb logic.

Your "case" about the neck injury is nice and slanted, and totally BOGUS in arguing for or against defensive medicine.

If all these malpractice attorneys were SO concerned about aptients welfare..they would have become doctors. But they realized they can just make more money SUING doctors.

Why don't all the lawyers just get a computer to diagnose them. Or just have every patient pay out of pocket for a PET scan that wont be covered by their insurance. Why not? Makes sense, right?

(Comment edited slightly to remove offensive language of angry commenter - ed.)

A comment on Malpractice Laws Face Changes and Debate

Daniel — Tue, 20 Feb 2007 17:25:31 GMT

Disclosure: I'm a medical student. I wanted to comment on your paragraph beginning "I want my doctor to use defensive medicine." I think what is lost in your description is the fact that any given test has a certain sensitivity, specificity, positive-predictive-value (PPV) and negative-predictive-value (NPV). [Briefly, Sensitivity = % of sick people who test positive ; Specificity = % of non-sick people who test negative ; PPV = % of people who test positive that are sick ; NPV = % of people who test negative who are not sick.] Additionally, certain tests carry risks of varying degrees for complications of varying severity. Complications for various tests can range from minor skin irritation to infection and death. In choosing whether to do tests, physicians have to take in to consideration all of those factors. Doing "everything available" sounds as if it's the right thing to do, as if it should be something I'd want for myself or my family, but having seen how medicine actually works, having seen how one test can lead to equivocal results that lead to further, more invasive tests (and sometimes complications), I no longer feel that way. If as health care practitioners we did "everything available" we'd often end up hurting a lot more than helping (and I'm not talking about hurting people's pocketbooks, but hurting them medically). One thing I've learned is that almost everybody will have some findings on some tests that are abnormal, which _could_ mean that they have something terribly wrong with them, or it could mean absolutely nothing at all. Medicine is full of uncertainties, and often times medical professionals end up "chasing" medical findings that are abnormal, but likely harmless, from test to test, possibly with complications. So as both a health care professional and as a patient, I don't want doctors to practice "defensive medicine", because what "defensive medicine" means in my mind is not just being medically conservative in your approach (that is, erring on the side of caution by getting tests), but being conservative to an _excess_-- not because of sound medical reasoning that takes into account sensitivity, specificity, PPV, and NPV but because one is worried about being sued by a legal team that will try and gloss over the facts that there is a lot of uncertainty in diagnoses, that getting a test is not always the right thing to do (even if in retrospect it would have been useful), and that getting tests (even if not directly harmful itself) can often lead down the path of further, potentially more invasive, tests.

Having said that, from how you described the neck injury case (without knowing the precise details), it seems on its face to be a clear cut medical error (if you are coming to the ER for trauma to your neck, you should get an X-ray, which is only associated with minimal risk from radiation, and is unlikely to lead to further tests-- that's standard of care in ERs no matter where one lives). But most things in medicine are not that clear cut; there is a lot more variation and lack of a clear-cut "right thing to do" for most medical choices. Saying you would want your physician to be conservative is one thing, but I think the term "defensive medicine" implies much more than being conservative, and rather implies trying to cover your ___ legally even if that might not be the best thing medically. What is legally safest for the doctors isn't always what is medically safest for the patient.

A comment on Malpractice Laws Face Changes and Debate

Diora — Tue, 20 Feb 2007 16:41:03 GMT

I want my doctor to use defensive medicine. I want them to use anything available to make sure they are on the right track. When you are talking about a member of your family, your child, you don't want a doctor taking shortcuts on some diagnostic test. It's just like a recent case where a patient went into the hospital because he had a fall and hurt his neck and they didn't X-ray. The next morning he woke up paralyzed from the neck down. They saved the cost of that X-ray, but the result is catastrophic because that person is paralyzed for the rest of his life.
I think you are forgetting that tests have risks too. Would you want your child to have a cat scan to rule out 1/100000 chance of something bad if this cat scan has a significantly larger chance of causing your child to have cancer 10 or 20 years later? The amount of radiation in ct scan is not that small. The amount of radiation in an X-ray may be small, but it adds up during the years.
In addition, some tests, although they appear harmless may have 10% chance of a false positive. The false positive needs to be evaluated by a painful and risky invasive test that may have 10% chance of serious, maybe even fatal complications. If your chance of having the condition you are testing for in the first place is extremelly small, you might be more likely to die from complications of the test than the condition you are testing for.

So it is not as clear as you think it is.

I am not a doctor, and I for one don't want my doctor to do tests that are more likely to harm me than to benefit me. I am angry at my 78-year old father's doctor for doing PSA without even informing my father about it, but his doctor does the test for "defensive reasons". I stopped going to physicals because of the potential for useless tests. I changed ObGyns because my former one felt she needed to do ultrasound every year for no good reason.

Just because you want something for yourself doesn't give you the right to impose it on the rest of us.

A comment on Trucking Accident Injures Man

Angus — Tue, 23 Jan 2007 12:09:16 GMT

Hey, John. Nice meeting with you guys today. Not used to that chilly Chattanooga weather though. Also not surprised there was an accident. I saw semis all over the place driving in. Good luck with the blog and let me know if you need anything.