A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests • Hacker News Board

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#101

Post by dredmorbius » Fri, Jul 27, 2018, 2:01 AM UTC

rayiner wrote: post #15

> Any law that limits the cases where patients can sue, or the amount of money they can collect, is likely to lower medical use in the hospital by less than the 5 percent they measured in their study. The telling thing about laws to address malpractice liability is that they typically are focused on capping large verdicts. But such laws are illogical: generally, large verdicts will be awarded where a doctor screwed u…

Or restorative remedies: provide the patient with the withheld treatment, and change protocols.

The Danish approach.

https://www.propublica.org/article/how-denmark-dumped-medica...

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#102

Post by darkerside » Fri, Jul 27, 2018, 2:03 AM UTC

arkades wrote: post #91

rayiner wrote: post #15

> Any law that limits the cases where patients can sue, or the amount of money they can collect, is likely to lower medical use in the hospital by less than the 5 percent they measured in their study. The telling thing about laws to address malpractice liability is that they typically are focused on capping large verdicts. But such laws are illogical: generally, large verdicts will be awarded where a doctor screwed u…

Showing you adhered to protocol is a valid defense. The problem is twofold: (1) Your insurer will usually prefer to settle rather than go to court, it's cheaper, so fuck your defense. (2) You still take the reputational and emotional hit of being sued. People discussing this rarely seem to get that docs are far more emotional about this than the money at risk merits. There are many things in play beyond "I don't want…

I think people tend to forget that doctors are also people

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#103

Post by darkerside » Fri, Jul 27, 2018, 2:07 AM UTC

LeifCarrotson wrote: post #55

SketchySeaBeast wrote: post #41

Earlier quoted context omitted.

No, but the initial investment does need to be recouped. The machines can cost into the millions.

It's true that the investment does need to be recouped for purchasing future machines, but once you have one, it's a sunk cost. And even then, if it's a big $5M machine [0] that lasts 10 years [1], and we generously assume it takes 1 hour per patient [2] and runs 12 hours a day, 300 days a year [3], the cost can be recouped if each test costs $140. But an MRI bill easily costs 20 times the cost to recoup the investme…

FWIW I'm guessing these are often purchased on borrowed money, so there may be interest to account for

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#104

Post by zelon88 » Fri, Jul 27, 2018, 2:20 AM UTC

I thought medical errors were the third leading cause of death in the U.S. with 10% of all deaths attributed to medical error.

With that error rate, is it fair to say that the extra tests are truly "unnecessary?"

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#105

Post by Spooky23 » Fri, Jul 27, 2018, 2:32 AM UTC

jl2718 wrote: post #17

Extra tests... the cost of diagnostics is a tiny fraction of the cost of doctor time, and most patients just go to the doctor to get the test. The doctor is an irellevant gatekeeper 90% of the time. How about we start talking about ‘extra’ doctor visits because patients don’t have access to tests. There are some diagnostics where this gatekeeping is literally causing a public health crisis. ‘Extra tests’ are only an…

With medicine becoming a cartel with sprawling medical networks, the tests become synonymous with cheese on a fast food burger — an extra quarter.

We have a old school PPO plan. My wife can go to the doctor for any purpose, and sure as hell there’s a pregnancy test for $5. If you’re on a statin, you’re worth about $600/year in lab tests. Not because of insurance companies, but because the GP or NP is the top of a sales funnel. They need to drive revenue in the network as the medical networks are less efficient.

The insurance company response is urgent care clinics, which the insurance companies spent millions lobbying for. Those are great for insurance because they hand out z-packs and nebulizers and send you home. Large employers self insure drugs, so it’s a profit center for everyone. Best part for them is the 32 year old unhealthy dude stays away from the both the outrageous ER and the GP and that statin prescription.

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#106

Post by patmcc » Fri, Jul 27, 2018, 3:38 AM UTC

jl2718 wrote: post #17

Extra tests... the cost of diagnostics is a tiny fraction of the cost of doctor time, and most patients just go to the doctor to get the test. The doctor is an irellevant gatekeeper 90% of the time. How about we start talking about ‘extra’ doctor visits because patients don’t have access to tests. There are some diagnostics where this gatekeeping is literally causing a public health crisis. ‘Extra tests’ are only an…

'Extra tests' can be dangerous in a few ways: x-ray and CT scans give you a significant dose of radiation, MRIs and mammograms have high false positive rates (that can lead to painful and potentially damaging biopsies), etc. Plus there are a subset of people who are incredible hypochondriacs - if they could schedule tests directly they would have MRIs daily, convinced that the last one had missed the problem. Some people need gatekeeping.

What we need is doctors and a medical system motivated by the right things (health and wellness of the patient) rather than purely by profit and fear of lawsuits.

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#107

Post by conanbatt » Fri, Jul 27, 2018, 5:28 AM UTC

jl2718 wrote: post #17

Extra tests... the cost of diagnostics is a tiny fraction of the cost of doctor time, and most patients just go to the doctor to get the test. The doctor is an irellevant gatekeeper 90% of the time. How about we start talking about ‘extra’ doctor visits because patients don’t have access to tests. There are some diagnostics where this gatekeeping is literally causing a public health crisis. ‘Extra tests’ are only an…

Spoken by someone that does not know how medicine is practiced.

In your same line of reasoning: if you waved all your legal rights to sue the doctor, and paid for him to prescribe your tests, you would find plenty that will feel comfortable doing so!

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#108

Post by conanbatt » Fri, Jul 27, 2018, 5:36 AM UTC

everdev wrote: post #14

patrickg_zill wrote: post #10

Wait until the NY Times finds out that c-sections have greatly increased because of high-dollar awards like the one that made John Edwards (yes the politician) a millionaire...

My wife is a doula and apparently the injury and mortality rates for mother and child are much higher than through natural childbirth. But because of their insurance coverage, if a mother or baby dies during natural childbirth the doctor is at greater risk for malpractice. So, they will rush mother's into C-section at any excuse (it saves them hours of work too not having to sit through a long labor). Unfortunately,…

Its not money and efficiency, its the law! Money and efficiency goals would satisfy your criteria by lowering death and extracting more money from the payer.

Its precisely a law trying to change money and efficiency that produces this result!

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#109

Post by conanbatt » Fri, Jul 27, 2018, 5:38 AM UTC

patrickg_zill wrote: post #10

Wait until the NY Times finds out that c-sections have greatly increased because of high-dollar awards like the one that made John Edwards (yes the politician) a millionaire...

On the other hand of that argument, a woman in the middle of labor can be given paperwork to sign extra expensive treatment on the spot. A practice I've been told happens a lot. And thats not a situation where you can make sound decisions.

Re: A Fear of Lawsuits Really Does Seem to Result in Extra Medical Tests

#110

Post by conanbatt » Fri, Jul 27, 2018, 5:42 AM UTC

subhobroto wrote: post #96

Fomite wrote: post #87

Earlier quoted context omitted.

"More data points do not hurt a diagnoisis if a proper scientific method is followed." Excess tests result in a higher number of false positives. This is just math. And those false positives have consequences.

> Excess tests result in a higher number of false positives True, but this is an engineering problem: 1. Just because some tests have a higher number of false positives does not mean all tests have a higher number of false positives 2. For those tests that do have a higher number of false positives, the well educated (and paid) professionals are aware and should have measures in place Eg: Bloom filters are fantastic…

Medicine is not engineering.

> Just because some tests have a higher number of false positives does not mean all tests have a higher number of false positives

No, but doing more tests leads to more false positives, which can lead to disastrous consequences. For example, someone could think they have aids through a false positive and lose their family, or choose to make an abortion, or start consuming preventive dangerous drugs, etc.

Not only that, you can bankrupt someone. It would surprise many how medicine is practiced differently based on available costs!

> For those tests that do have a higher number of false positives, the well educated (and paid) professionals are aware and should have measures in place

Yes, the measure is not to do them unless the symptoms and the DDX fit, along with other criteria.

I wonder what kind of doctor you've been to.