Hacker News Board Hacker News, browsed like a classic message board
Live data from Hacker News

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

nytimes.com

Post reply on HN
Print view View original

31–40 of 127 posts

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

#31

Post by ceejayoz »

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.

That's a pretty reasonable filter to have. Sure, there'll be some cases like yours where you've got enough knowledge to request a specific surgery, but for every one of those there's likely to be several "your back pain is caused by weight and posture, surgery isn't indicated" (and the occasional "why don't we see a psychiatrist about that radio the CIA put in your brain instead of a neurosurgeon...") that the GP can winnow out at a quarter of the cost and without tying up an already in-demand specialist.

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

#33

Post by mywittyname »

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…

A frivolous lawsuit costs the patient (or patient's lawyer) a lot. Hospitals get sued all the time and they have an entire legal department staffed and ready to handle subpoenas.

You still have to prove damages. Which means getting treatment from another hospital for whatever mistake was made, then proving that the mistake was caused by the treatment you received at another hospital.

As stated elsewhere, my partner has been named in dozens of malpractice lawsuits and every one she was deposed for she felt was legitimate. There were a few where she told me privately that she hopes the people win.

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

#34

Post by Retric »

noonespecial wrote: post #9
Retric wrote: post #3

Earlier quoted context omitted.

As someone that lost a close family member because a doctor did not do one of those extra tests I think they are underrated. Cost vs benefit on this stuff is hard to get right, but lives are often on the line.

My condolences. But as someone whose father lost a kidney and suffered much un-needed anxiety and pain because of a false positive on one of those "extra tests" (and the general culture of treat-until-lawsuit-proof), I humbly request we meet in the middle.

The middle would trade X deaths for X case of pain and wasteful spending which is not a fair trade.

Trading 5-100 of your fathers cases for 1 life is IMO a worthwhile trade as we want a system heavily biased toward savings extra lives.

PS: It's the rate of false positives vs saved lives that cause wasted treatments not the number of tests.

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

#35

Post by awb »

Xixi wrote: post #24
everdev wrote: post #14

Earlier quoted context omitted.

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.

From what I understand C-sections are much riskier for the mother than we might think. It's significant surgery which can always lead to complications or infection.

The other factor is delivering a child naturally that gets stuck and didn't get enough oxygen but lives is probably the most expensive outcome for doctors because that child can live with severe physical or mental handicaps and need support the rest of their lives.

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

#36

Post by tptacek »

rayiner wrote: post #27
everdev wrote: post #14

Earlier quoted context omitted.

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 develo…

A nit: is it really true that C sections are primarily for high-risk pregnancies? C sections are at an all-time high. Both my kids were delivered by C section after attempts to induce labor, but those inductions were based simply on calendar due dates assigned early in the pregnancy. People schedule C sections in advance.

More importantly: anyone who has had a C section before is likely to deliver all future children via C section; it's not a requirement, but a normal birth after C section is a special arrangement.

Finally: C section itself is a traumatic surgery with long-lasting health effects for the mother. It's routine, but still a big deal.

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

#37

Post by PhasmaFelis »

SketchySeaBeast wrote: post #21
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…

> MRI's and CAT scans are costly machines, especially compared to 15 minutes of a doctors time.

I know the machines themselves are very expensive, but what are the costs to run a test? Does it draw ruinous amounts of power when running, or are there expendable materials involved?

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

#38

Post by dragonwriter »

tptacek wrote: post #36
rayiner wrote: post #27

Earlier quoted context omitted.

> 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 develo…

A nit: is it really true that C sections are primarily for high-risk pregnancies? C sections are at an all-time high. Both my kids were delivered by C section after attempts to induce labor, but those inductions were based simply on calendar due dates assigned early in the pregnancy. People schedule C sections in advance. More importantly: anyone who has had a C section before is likely to deliver all future children…

> A nit: is it really true that C sections are primarily for high-risk pregnancies?

C-sections are very disproportionately used for those, though perhaps not primarily; in relation to the risk statistics upthread, is the same basic impact. You cant just compare adverse outcome rates for C-section and vaginal birth without taking into account factors associated with adverse outcomes which also make C-section a more likely event.

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

#39

Post by barking »

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...

Correct me if I am wrong but reading his wikipedia page makes it look like he was acting as a lawyer for clients rather than suing on his own behalf.

https://en.wikipedia.org/wiki/John_Edwards

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

#40

Post by noonespecial »

Retric wrote: post #34
noonespecial wrote: post #9

Earlier quoted context omitted.

My condolences. But as someone whose father lost a kidney and suffered much un-needed anxiety and pain because of a false positive on one of those "extra tests" (and the general culture of treat-until-lawsuit-proof), I humbly request we meet in the middle.

The middle would trade X deaths for X case of pain and wasteful spending which is not a fair trade. Trading 5-100 of your fathers cases for 1 life is IMO a worthwhile trade as we want a system heavily biased toward savings extra lives. PS: It's the rate of false positives vs saved lives that cause wasted treatments not the number of tests.

How 'bout 1000. 10000? Now were just arguing numbers. Don't forget the opportunity cost of unneeded treatments using resources that could have "saved" others as well.

We're taking many paths but ending up at some sort of rationing in the end. There's no easy answers.

Post reply on HN