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

71–80 of 127 posts

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

#71

Post by dragonwriter »

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.

> If a doctor is sued for malpractice, that means they made a mistake.

No, it means that someone has a story about an adverse outcome that they think can be blamed on the doctor making a mistake; it doesn't mean either that the adverse outcome actually occurred or that it was caused by the doctor making a mistake.

That's why we have trials.

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

#72

Post by grasshopperpurp »

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.

>Denmark offers a radically different alternative, as do similar programs in other Scandinavian countries and New Zealand. To be sure, these countries have nationalized health care systems, unlike the public-private model in the U.S. But alternative responses to patient harm have been tried on a smaller scale. Virginia, for example, has a program designed to compensate for severe neurological childbirth injuries that is similar in some ways to the Danish system.

Common to all these programs is a commitment to provide information and compensation to patients regardless of whether negligence is involved. That lowers the bar of entry for patients and doesn’t pit doctors against them, enabling providers to be open about what happened.

This seems like a much better system.

https://www.propublica.org/article/how-denmark-dumped-medica...

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

#73

Post by briandear »

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…

Most meritorious? While not a medical case, the McDonald’s coffee verdict certainly wasn’t meritorious. Person burned when they spilled hot coffee, awarded millions because coffee was hot.

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

#74

Post by rayiner »

everdev wrote: post #42
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…

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, anesthesiolo…

> This source seems anti-natural from birth to breastfeeding.

Well yes, because the author is a doctor. The maternal death rate from "natural" child birth is 1,000-1,500 per 100,000 births. In the U.S., it is just 26.4.

> 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.

The data in fact shows no evidence that it is being "over-prescribed." If it were, you would expect to see worse maternal outcomes in countries with higher rates of C sections, and you do not.

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

#75

Post by briandear »

dragonwriter wrote: post #30
mrfredward wrote: post #28

Earlier quoted context omitted.

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.

I am sorry but you are just completely wrong. Exactly the opposite of what you said is true:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701901/

“In summary, there exists considerable evidence that medical malpractice reform measures reduce medical malpractice awards and also the losses incurred by medical malpractice insurance companies.”

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

#76

Post by Broken_Hippo »

patrickg_zill wrote: post #53
SkyPuncher wrote: post #23

Earlier quoted context omitted.

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.

I agree; however the first thing he did was to order a CT scan to confirm the diagnosis and get the exact location. So the family doctor visit was thus duplicative.

Confirming the diagnosis might or might not be prudent, depending on the injury and how likely false positives are in those sorts of injuries. Confirming the exact location shortly before the surgery? That might be prudent, especially if the damage was likely to move a bit or become worse during the waiting time. This should have been explained better.

Otherwise, I'd agree that the test was unnecessary and shouldn't be done a second time. Weirdly, it could have asily been that the first test wasn't in his particular working network - I've seen this done in hospitals before (redoing tests from places not in the hospital's network). This still isn't an issue with the referral system, though, but points to other problems.

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

#77

Post by daniel-cussen »

briandear wrote: post #73
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…

Most meritorious? While not a medical case, the McDonald’s coffee verdict certainly wasn’t meritorious. Person burned when they spilled hot coffee, awarded millions because coffee was hot.

> Certainly wasn't meritorious

Could you read a little more about that case?

1) McDonald's had burned hundreds of people by that point, as the plaintiff's lawyer said in "Hot Coffee", "they were on notice." They served it that hot IIRC because it would stay hot slightly longer, even though lowering the serving temperature a tiny amount reduced burning disproportionately and would have prevented that and hundreds of other accidents.

2) The server didn't actually attach the lid to the cup.

3) She had horrible burns, 3rd degree.

4) McDonald's received an offer to pay for her ~$10,000 medical expenses, and counter-offered $600.

5) This was an old lady who had never sued anyone in her life.

6) She ultimately gave up on life in her old age because of the shaming.

"Hot Coffee" opened my eyes about the whole matter. I suggest you watch it.

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

#78

Post by ryandrake »

imglorp wrote: post #64
patrickg_zill wrote: post #53

Earlier quoted context omitted.

I agree; however the first thing he did was to order a CT scan to confirm the diagnosis and get the exact location. So the family doctor visit was thus duplicative.

I hope the specialist didn't get a kickback from the imaging company

The US healthcare system is a raging river of money, and you can bet that every doctor, lab, hospital and other medical service has their buckets dipped into it. The entire system seems to be set up to squeeze as many billable office visits out of you as possible.

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

#79

Post by briandear »

Is there empirical evidence for “Defensive Medicine?”

https://www.ncbi.nlm.nih.gov/pubmed/19201500/

“The net effects of medical malpractice tort reform on health insurance losses: the Texas experience”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5701901/

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

#80

Post by ryandrake »

mywittyname wrote: post #25
darkerside wrote: post #5

Earlier quoted context omitted.

> 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. D…

> 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.

What? In the USA, it’s the customer who eats the cost of the test. 1. The doctor tells you to go do all these tests. 2. Neither the doctor, the testing lab, the hospital, or the insurance company knows which ones will be covered by insurance. 3. You do the tests. 4. Insurance company, months later, says “Surprise, sucker! We won’t cover these tests so you have to pay $N,000!” 5. The lab and doctor says “You signed the paper agreeing to cover the costs. F-you Pay me.”

Post reply on HN