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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

#21

Post by SketchySeaBeast »

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…

Firstly, I'll caveat with this that I'm Canadian - I see different issues in my system than the for profit model. Regarding the cost - I guess that depends on the tests themselves - MRI's and CAT scans are costly machines, especially compared to 15 minutes of a doctors time. Also, how does that affect availability of that equipment for higher priority patients?

There's also the question of ethics - how invasive of a procedure does one do as an extra test before it's an issue? My wife is a sonographer - ultrasounds aren't completely diagnostic, only indicative, and a lot of the time the patient will have to go to a more extreme diagnostic to confirm. Should we be skipping the ultrasound and going straight to the biopsy every time?

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

#22

Post by mywittyname »

grasshopperpurp wrote: post #12
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…

No idea why this is being downvoted. Maybe they missed the qualifier? > . . . at least in a for-profit systems.

I don't get it either. People outside of healthcare probably aren't aware of how ridiculously common it is for medical mistakes to be made. Dozens of overworked people are coordinating with one another to take care of you.

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

#23

Post by SkyPuncher »

patrickg_zill wrote: post #20
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…

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.

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

#24

Post by Xixi »

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,…

But are the injury and mortality rates higher because C-sections are riskier, or because high risk childbirth are done through C-section? You need to control for the prior, otherwise the statistic is not very useful.

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

#25

Post by mywittyname »

darkerside wrote: post #5
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…

> 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. The study cited in the article would seem to rebut that quite vigorously. FTA: > They found that the possibility of a lawsuit increased the intensity of health care that patients received in the hospital by about 5 percent — and that those patients who got the extra care were no be…

An side of this that most people aren't aware of is that insurance companies will refuse to pay for any medical test they deem to be unnecessary. So, while a doctor may order additional tests to "CYA," it's pretty likely that the hospital won't be reimbursed for all of them and will just eat the cost of the tests. And, while a hospital may charge thousands for a test, the actual costs might only be in the hundreds. Depending on the hospital system, this can be a win-win because the tax write-off can be worth more than the actual test costs.

The healthcare system in the US is insane.

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

#26

Post by pc86 »

grasshopperpurp wrote: post #12
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…

No idea why this is being downvoted. Maybe they missed the qualifier? > . . . at least in a for-profit systems.

Probably because it's flat out wrong and shows a shockingly incorrect view of how things actually work.

> The patient can only sue if the patient has been harmed.

No, the patient can sue for whatever reason they want to. The doctor's malpractice insurance is going up regardless. Even a completely frivolous lawsuit will cost the physician real money out of his or pocket for years to come, not to mention the cost (if they choose to pursue it) of counter-suing the patient.

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

#27

Post by rayiner »

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,…

> My wife is a doula and apparently the injury and mortality rates for mother and child are much higher than through natural childbirth.

That is of course true, because C sections are primarily used in high-risk pregnancies and in emergencies. But what you actually care about is the counter-factual: if a given set of deliveries were "natural" rather than a C section, would mortality go up or down? It's hard to develop studies to answer that counter-factual. But there is good evidence that C-section rates are negatively correlated with mortality (i.e. they lower deaths) up to about 20% of deliveries, and have no positive or negative effect beyond that: http://www.skepticalob.com/2017/10/more-wailing-and-gnashing....

Indeed, there is new evidence that "natural" births are in the long term bad for mothers, dramatically increasing the risk of things like incontinence later in life: http://www.skepticalob.com/2018/03/what-if-c-sections-are-be.... As a practical matter, these negative effects will impact far more women than differences (if any) in morality rates.

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

#28

Post by mrfredward »

dahdum wrote: post #16

Aren't a lot of these costs baked into all services due to malpractice insurance itself? If these doctors could be sued by some of their patients (the families), they still need to cover the cost of that insurance. Beyond that, once defensive medicine is the status quo, why would they make a choice to not order their usual defensive panels? They aren't paying for them themselves.

True, but here's a point the NYT missed: caps on malpractice claims don't have to change how doctors practice medicine to reduce costs. By capping liability, they should make malpractice insurance cheaper and thus reduce the cost of providing care.

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

#29

Post by grasshopperpurp »

pc86 wrote: post #26
grasshopperpurp wrote: post #12

Earlier quoted context omitted.

No idea why this is being downvoted. Maybe they missed the qualifier? > . . . at least in a for-profit systems.

Probably because it's flat out wrong and shows a shockingly incorrect view of how things actually work. > The patient can only sue if the patient has been harmed. No, the patient can sue for whatever reason they want to. The doctor's malpractice insurance is going up regardless. Even a completely frivolous lawsuit will cost the physician real money out of his or pocket for years to come, not to mention the cost (if t…

That part is incorrect; however, the overall message of the post is correct. In a for-profit system, it's the patient's only recourse. Don't like it? Fight against for-profit healthcare.

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

#30

Post by dragonwriter »

mrfredward wrote: post #28
dahdum wrote: post #16

Aren't a lot of these costs baked into all services due to malpractice insurance itself? If these doctors could be sued by some of their patients (the families), they still need to cover the cost of that insurance. Beyond that, once defensive medicine is the status quo, why would they make a choice to not order their usual defensive panels? They aren't paying for them themselves.

True, but here's a point the NYT missed: caps on malpractice claims don't have to change how doctors practice medicine to reduce costs. By capping liability, they should make malpractice insurance cheaper and thus reduce the cost of providing care.

Caps on malpractice claims exist in numerous jurisdictions, and studies have shown them to have no discernable effect on either total healthcare costs or even specifically on malpractice insurance costs.
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