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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

#41

Post by SketchySeaBeast »

PhasmaFelis wrote: post #37
SketchySeaBeast wrote: post #21

Earlier quoted context omitted.

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?

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

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

#42

Post by everdev »

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…

This source seems anti-natural from birth to breastfeeding.

Medicine can certainly help improve things but if you've been through the birth process multiple times it's clear that doctors try to steer you towards C-section.

Several of them have confided to us that it's primarily because of insurance. The hospital procedures want women in C-section for a few reasons:

1. The procedure is expensive (surgeon, anesthesiologist, etc.)

2. The procedure is fast (30-45min) and can be scheduled allowing the hospital to deliver more babies with less staff

3. The recovery period is longer (2-3 day recovery period as opposed to 8-24 hours for natural birth) generating revenue for longer while only being care from relatively inexpensive nurses.

Sure, there are many times when C-section is appropriate and has saved lives, but it's currently being over prescribed because of hospital guidelines that doctor's need to follow or risk malpractice liability.

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

#43

Post by DanBC »

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.

You're making the mistake of thinking that over-testing, over-diagnosis, and over-treatment saves lives, when it probably doesn't, and may well decrease length of life as well as quality of life.

The US has massive rates of testing for various stuff. It also has a lower life-expectancy than other similar nations.

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

#44

Post by pc86 »

grasshopperpurp wrote: post #29
pc86 wrote: post #26

Earlier quoted context omitted.

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.

Whether healthcare is for-profit or non-profit does not change how the legal system works.

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

#45

Post by ugh123 »

barking wrote: post #39
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

Thats right - he's effectively acting as an "ambulance chaser" - a legal role that often twists, embellishes, and often straight up lies to extract $$$ from hospitals and doctors.

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

#46

Post by tptacek »

dragonwriter wrote: post #38
tptacek wrote: post #36

Earlier quoted context omitted.

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 li…

I don't think this is unknowable; just a couple minutes of Googling turned up a bunch of studies. Consumer Reports posted an analysis from journal articles indicating that maternal mortality from C sections is strongly correlated with specific hospitals; since the predicates for an emergency C section generally aren't correlated, that strongly suggests it's the procedure and not the circumstances that are to blame. The major causes of mortality due to C section include sepsis and anaesthesia errors (this happened to my wife during the birth of our first kid), which are also intrinsic to the surgery and not to the circumstances of the pregnancy.

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

#47

Post by Retric »

noonespecial wrote: post #40
Retric wrote: post #34

Earlier quoted context omitted.

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.

I doubt they would have removed a liver if the risks where that low.

So, really it's saving lives at the cost of a fixed but low number of false positives and a lot of wasted tests not a 10,000 extra removed livers per life saved.

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

#48

Post by Xixi »

awb wrote: post #35
Xixi wrote: post #24

Earlier quoted context omitted.

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 th…

The problem is not that C-sections are riskier than "we" might think, and certainly not that I might think because I'm extraordinarily unlikely to be in a situation to decide whether to do one or not. The important question is whether they are riskier than the alternative (natural child delivery) in the specific instances where a C-section is practiced.

It's entirely plausible that C-sections are done too casually and doing them less often would result in better outcomes. It's also plausible that they are not. The cynical in me finds very plausible that the answer to that question varies widely doctor to doctor.

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

#49

Post by Retric »

DanBC wrote: post #43
Retric wrote: post #34

Earlier quoted context omitted.

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.

You're making the mistake of thinking that over-testing, over-diagnosis, and over-treatment saves lives, when it probably doesn't, and may well decrease length of life as well as quality of life. The US has massive rates of testing for various stuff. It also has a lower life-expectancy than other similar nations.

US life expectancy rate relates to poor healthcare and poor public health more than over testing. When you let a large chunk of the population die from treatable illnesses it's hard to make up for that by treating a subset even better than average.

The US homeless population for example is 1.56 million people and they don't get good healthcare.

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

#50

Post by DanBC »

Retric wrote: post #49
DanBC wrote: post #43

Earlier quoted context omitted.

You're making the mistake of thinking that over-testing, over-diagnosis, and over-treatment saves lives, when it probably doesn't, and may well decrease length of life as well as quality of life. The US has massive rates of testing for various stuff. It also has a lower life-expectancy than other similar nations.

US life expectancy rate relates to poor healthcare and poor public health more than over testing. When you let a large chunk of the population die from treatable illnesses it's hard to make up for that by treating a subset even better than average. The US homeless population for example is 1.56 million people and they don't get good healthcare.

The simple message is that over testing causes harm and does not reduce all cause mortality.
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