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

#121

Post by LorenPechtel » Fri, Jul 27, 2018, 4:05 PM UTC

SkyPuncher wrote: post #23

patrickg_zill wrote: post #20

Earlier quoted context omitted.

That is very accurate... I had an injury that I knew required specific surgery, but when I called the surgeon's office to make an appointment I was told that they only accepted referrals from family doctors, that is, I had to pay to visit a family doctor first. This applies nowadays to most specialists as well.

I don't really consider this a problem. Specialists are packed to the gills already and very expensive. Specialists don't want to spend time with patients who don't actually need specialized care and insurance doesn't want to pay specialists without first qualifying the issue.

In general I think it's a good idea. However, once someone has an ongoing medical issue that requires a certain type of specialist that gate should be left open. Keeping having to go back to your primary just to get back to the specialist you actually need is wasteful.

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

#122

Post by LorenPechtel » Fri, Jul 27, 2018, 4:07 PM UTC

Spooky23 wrote: post #105

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 sal…

Urgent care centers are about keeping people out of the ER--patients with medical issues that shouldn't really wait to get in with their primary, but which don't rise to ER-level issues.

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

#123

Post by LorenPechtel » Fri, Jul 27, 2018, 4:09 PM 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,…

C-sections are done when something isn't going right, or when there is some medical issue against natural childbirth. You can't compare the risks with natural childbirth because you're looking at two different populations.

Your argument is like saying doctors make people sick because someone in a doctor's office is more likely to be sick than someone on the street.

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

#124

Post by LorenPechtel » Fri, Jul 27, 2018, 4:12 PM UTC

zelon88 wrote: post #104

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?"

That's a severe distortion of the reality. Most of those "errors" are not a healthy patient dies, but cases where the patient was dying, the only question being exactly when.

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

#125

Post by LorenPechtel » Fri, Jul 27, 2018, 4:15 PM UTC

subhobroto wrote: post #60

I see no issue with Extra Medical Tests. More data points do not hurt a diagnoisis if a proper scientific method is followed. The primary issue here is the resulting cost. As the article points out: "about 26 percent of every dollar spent." You probably won't complain paying 26 cents for a $1 popsicle, but if the same popsicle cost you $100, you might be upset paying $26. But is not the bigger question: Why is the po…

False positives. My wife underwent multiple tests including a nuclear one to learn that her kidneys aren't exactly the normal shape. Completely harmless.

However, you do have something of a point. The normal screening tests should be able to be ordered by an insurance company or by the patient themselves. If you don't have any other medical issues that need a doctor there's no reason for a visit unless the tests find an abnormality.

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

#126

Post by hobbyjogger » Fri, Jul 27, 2018, 5:17 PM UTC

TeMPOraL wrote: post #114

rayiner wrote: post #95

Earlier quoted context omitted.

> 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.

That's essentially Rayiner's point--focusing on large payouts is not an effective response to this concern.

In states with a cap on the maximum medmal claim, the cap often "saves" the defendant money in situations where docs/hospitals really did screw up badly. But that cap has not effect on small, frivolous lawsuits where the doc/hospital weren't at fault.

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

#127

Post by todd8 » Sat, Jul 28, 2018, 11:26 AM UTC

mywittyname wrote: post #18

malcolmgreaves wrote: post #6

Earlier quoted context omitted.

A patient can sue for any reason. They can be wrong and sue. It's then up to the physican to pay costs for legal defense (i.e. medical malpractice insurance). If the patient is wrong, then the physican can counter-sue. This whole dance is very expensive and, worse, time consuming (which, for a doc, is the ultimate resource). This cost ends up on the patient ad the doc must raise prices to account for the new insuranc…

Patients normally sue a hospital system though. My partner has been involved in dozens of malpractice lawsuits over the years because every person who interacted with the patient during their stay is named in the lawsuit, not just the doctor(s) who treat them. Hospitals have staff lawyers whose job it is to deal with lawsuits. So it's not terribly time-consuming for doctors outside of depositions. It's safe to say th…

Hacker news readers may not realize that joint liability exists in many states. Under this doctrine, the plaintiff can collect all awarded damages from even very peripherally involved people. A person with deep pockets can end up paying for others mistakes.

For example, a plaintif’s attorney might drag everyone into a lawsuit they can over a disappointing surgical result. The jury could be persuaded that an operating room nurse is 1% liable for a failed operation and the surgeon 99% responsible. If the surgeon can’t pay their part of a two million dollar judgement (brand new doctor perhaps) the nurse may end up paying the two million (maybe the nurse is married to a software engineer).