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

nytimes.com

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

#111

Post by conanbatt »

sandworm101 wrote: post #2

>> In the federal government and in states, there are frequent proposals to limit medical liability, but there have been no serious efforts to eliminate medical malpractice rights altogether. Damb right. Take away a patient's right to hold doctors accountable and things go south very quickly, at least in a for-profit systems. >>But American doctors often rail against the country’s medical malpractice system, which th…

> he patient can only sue if the patient has been harmed. They aren't performing the extra tests in case just wakes up and decides to sue them. They perform the extra tests so that they don't miss something that could harm the patient so badly that they sue.

Unfortunately this is not how good medicine is practiced. Medicine is not a straightforward hard-science. Tests are expensive, patients dont follow through, they have personal consequences, chances you got something are 100% but chances you got something specific are 0.0001%.

It is digestible for a doctor to have liability but compare it to other professions: does a web developer that botched a UI for a bank transfer and introduces some consequence go to jail for robbery? Doctors have too high a burden. And a decision or an oversight that makes someone die could be as stupid as a misprint on a paper.

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

#112

Post by conanbatt »

n8henrie wrote: post #67
joshuaheard wrote: post #62

If a doctor is sued for malpractice, that means they made a mistake. If they are performing extra tests to avoid malpractice, that means they are performing extra tests to avoid making mistakes. That is a good thing.

So if a physician were to do every test on every patient every time, could they expect to never be sued? Would that be a good thing? “1 of everything please.”

You would go for an annual checkup and you get a CAT-scan and get cancer from it, then the doctor can say "Well, now we know you have it, you wouldnt without the test!"

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

#113

Post by Fomite »

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…

"1. Just because some tests have a higher number of false positives does not mean all tests have a higher number of false positives"

No - this is a math problem. As you do tests on low prevalence populations (inherently what you're doing when you say 'excess tests'), positive predictive value drops. Sure, it will drop more for worse tests, but this is a trait of all tests.

"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"

One of the problems is distinguishing between "This thing is here" and "This is a clinical problem". For example, if I give you the (highly sensitive) PCR test for C. difficile, you may very well have C. difficile in your guts. But that doesn't mean that's what's making you sick.

Similarly, there are a number of cancer screening tests that will detect cancers that will kill you decades after something else does - including, potentially, the surgery to deal with said finding.

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

#114

Post by TeMPOraL »

rayiner wrote: post #95
ghein wrote: post #61

Earlier quoted context omitted.

Large verdicts have been delivered where no or minimal injury was suffered. As others have mentioned, John Edwards had great success as a lawyer suing over cerebral palsy, claiming that it was caused by actions during delivery. While possible, most cases are caused by other factors such as infections, IVF, or low birthweight. At trial, you have a sympathetic plaintiff with large needs vs a "rich" doctor and hospital.…

> Large verdicts have been delivered where no or minimal injury was suffered. We live in a country of 300 million people. Every permutation of things that can happen has happened. But that doesn't mean that large verdicts "where no or minimal injury was suffered" happen often enough to account for a significant share of medical malpractice payouts. There was a Harvard study that looked at this issue pretty systematic…

Is the monetary amount of payouts important at all for the issue at large?

The doctors/soon-to-be-doctors I've talked to/read aren't worried about the amount of money that leaves hospitals in malpractice payouts. They're worried that it's too easy to sue a doctor / hospital over arbitrary fabricated bullshit and win.

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

#115

Post by TeMPOraL »

wingspar wrote: post #100
c3534l wrote: post #81

Earlier quoted context omitted.

I remember looking up a meta analysis back when Obamacare was being debated about why doctors have a skewed perception of the liklihood of being sued (that part is apparently not controversial in the literature). Most of the reasons found were just basic human psychological errors (I heard Bob got sued and I'm not taking into account that I know a thousand people and that Bob is only giving me his side of the story).…

>why doctors have a skewed perception of the liklihood of being sued (that part is apparently not controversial in the literature). The correct place to look is not the perception of doctors, but the conclusions from actuarials in the setting if insurance rates. If it was just a perception bias in the doctors, then it wouldn’t be reflected in the insurance premiums.

Doesn't insurance take perception into account too? If the true chance of a lawsuit is X, but doctors believe it's some Y that's greater than X, then an insurance company could price this as if it was Y, and get (Y-X) in free money. Is there enough competition in this space to prevent that?

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

#116

Post by joshuaheard »

psychometry wrote: post #69
joshuaheard wrote: post #62

If a doctor is sued for malpractice, that means they made a mistake. If they are performing extra tests to avoid malpractice, that means they are performing extra tests to avoid making mistakes. That is a good thing.

There's an error in literally every sentence you just wrote. 1. A person can be sued without being guilty in a criminal or civil sense. 2. They are performing extra tests to cover their asses, not to avoid making mistakes. 3. It is clearly not a good thing as shown by the authors of the study.

I'm a lawyer and have sued doctors for malpractice. Before bringing such a lawsuit, the lawyer hires an expert witness, another doctor, who testifies there is malpractice. Then, you are facing a deep-pocket insurance defense law firm. Med mal cases are costly and in some states, the damages are limited. No med mal lawyer worth their salt would bring a case unless there was clear malpractice.

Most med mal cases are failure to diagnose. That is, the doctor fails to find out what is wrong with you, and you are harmed as a result. If the doctor runs a battery of tests, however, they can properly diagnose the disease and not harm the patient. For a nominal fee, the doctor can save someone's life. This may be bad for the system as a whole, but it is good for the individual patient.

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

#117

Post by TeMPOraL »

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…

> People discussing this rarely seem to get that docs are far more emotional about this than the money at risk merits.

There's also the risk of losing right to practice medicine - that is, being banned from providing the very service you spent the best part of your life specializing in.

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

#118

Post by mnm1 »

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…

Yup and doctors know how to milk it for the most money. Instead of sending an email with their findings, you need another appointment just to be told what could have been said over the phone or email. Worse are checkup appointments. You get a treatment then the next time you go in for ... What exactly? To make sure that saline injection didn't kill you? It's fraud and total bullshit and wastes everyone's time. I don't blame doctors, I blame our lack of a proper healthcare system in which they need to get theirs because only certain things are billable (the phone call or email aren't). Doctors know that every trivial office visit they are making serious money. My copay is $50 for a specialist. That's for usually only a few minutes and hides the egregious sums that insurance pays. Yes, their time is valuable but so is my money and paying exorbitant amounts to see a doctor who says nothing and does nothing other than send you for a test or making sure you're still alive after your last dose of an over the counter pain reliever (I'm not making that up) is fraud, fraud we all pay for as a nation because we can't have a proper healthcare system where patients aren't used for profit and lives are saved for the sake of saving lives not lost for the sake of profits.

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

#119

Post by MaupitiBlue »

joshuaheard wrote: post #116
psychometry wrote: post #69

Earlier quoted context omitted.

There's an error in literally every sentence you just wrote. 1. A person can be sued without being guilty in a criminal or civil sense. 2. They are performing extra tests to cover their asses, not to avoid making mistakes. 3. It is clearly not a good thing as shown by the authors of the study.

I'm a lawyer and have sued doctors for malpractice. Before bringing such a lawsuit, the lawyer hires an expert witness, another doctor, who testifies there is malpractice. Then, you are facing a deep-pocket insurance defense law firm. Med mal cases are costly and in some states, the damages are limited. No med mal lawyer worth their salt would bring a case unless there was clear malpractice. Most med mal cases are fa…

Fellow trial lawyer here, and ditto.

For context, a “simple” failure to diagnose case against a radiologist is going to cost me close to $20,000 out of pocket, and hundreds of hours of my time - not something I do on a whim.

A judges’s admin assistant that I frequently deal with recently retired. Someone asked her what advice she had for attorneys. Her response - don’t file med mal cases because they’re losers, and I practice in one of the top 5 “judicial hell holes” in America.

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

#120

Post by LorenPechtel »

rayiner wrote: post #95
ghein wrote: post #61

Earlier quoted context omitted.

Large verdicts have been delivered where no or minimal injury was suffered. As others have mentioned, John Edwards had great success as a lawyer suing over cerebral palsy, claiming that it was caused by actions during delivery. While possible, most cases are caused by other factors such as infections, IVF, or low birthweight. At trial, you have a sympathetic plaintiff with large needs vs a "rich" doctor and hospital.…

> Large verdicts have been delivered where no or minimal injury was suffered. We live in a country of 300 million people. Every permutation of things that can happen has happened. But that doesn't mean that large verdicts "where no or minimal injury was suffered" happen often enough to account for a significant share of medical malpractice payouts. There was a Harvard study that looked at this issue pretty systematic…

Consider what used to be the poster-boy for the lawyers blaming the insurance system here:

$6 million verdict that was still being fought in the courts many years later rather than simply paid.

Oops, the reality: Trial #1: The woman was determined to be 90% at fault for her baby's problems, the law here doesn't let you collect if you're found more than 50% at fault. Trial #2, this time filed in the name of the baby. Still 90% to the woman. However, the jury assigned 5% to one doctor who examined her once several hours before the birth. He's the only one with anything, the whole $6 million verdict landed on him.

If that's what the lawyers consider a good case...

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