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

nytimes.com

81–90 of 127 posts

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

#81
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…

I remember looking up a meta analysis back when Obamacare was being debated about why doctors have a skewed perception of the liklihood of being sued (that part is apparently not controversial in the literature). Most of the reasons found were just basic human psychological errors (I heard Bob got sued and I'm not taking into account that I know a thousand people and that Bob is only giving me his side of the story). But I do also remember the point being brought up that medical malpractice lawsuits follow a power law distribution where a minority of doctors get sued the most and repeatedly, while the vast majority of doctors may occasionally get sued, but rarely lose (yet it creates a perception that they were lucky, even though they're good doctors).

I think my takeaway from that analysis was that doctors are just as illogical as everyone else when it comes to things that aren't medicine. So you shouldn't really be surprised that they're unduly influenced by large, visible, and rare lawsuits, because that's how everyone works psychologically.

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

#82
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.

These were the injuries sustained by the coffee, which was more than just "hot":

https://qph.fs.quoracdn.net/main-qimg-4820c7e31a90a1b89482c6...

and http://www.gruberlawgroup.com/wp-content/uploads/2016/04/ste...

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

#83

Earlier quoted context omitted.

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.”

Reduced Awards =! Reduced Premiums or Costs

Texas seems to have set caps so low that it has reduced premiums for doctors. But "making malpractice cheaper" isn't much of a policy goal.

Nationally,'tort reform' caps have had mixed results. "...better-designed studies show that damages caps reduce liability insurance premiums. The effects of damages caps on defensive medicine, physicians’ location decisions, and the cost of health care to consumers are less clear." [0]

[0] https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2690332/

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

#84

Earlier quoted context omitted.

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 o…

I think one of the reasons they served it so hot was that they brewed it very hot. The reason they brewed it very hot was because the hotter you brew it the more flavor you can extract. The more flavor you can extract from the beans, the more liquid coffee you can produce from the same amount of coffee grounds.

They made it dangerously hot because it was marginally more profitable.

At trial they claimed they served it that hot because people wanted it to be hot when they arrived at their destination, but their own research showed that people consumed their food, including coffee, during their commute.

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

#85
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.

This a feature, not a bug.

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

#86
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…

"‘Extra tests’ are only an issue because of the untreated disease they reveal"

This is just not true. For example, right now, there's a lot of interest in 'diagnostic test stewardship' in hospitals to avoid overtesting, because it can lead to serious problems, like causing diseases (due to treatment with antibiotics) or infections.

Similarly, false positives for cancer screenings, etc.

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

#87

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…

"More data points do not hurt a diagnoisis if a proper scientific method is followed."

Excess tests result in a higher number of false positives. This is just math. And those false positives have consequences.

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

#88

Earlier quoted context omitted.

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

It's true that the investment does need to be recouped for purchasing future machines, but once you have one, it's a sunk cost. And even then, if it's a big $5M machine [0] that lasts 10 years [1], and we generously assume it takes 1 hour per patient [2] and runs 12 hours a day, 300 days a year [3], the cost can be recouped if each test costs $140. But an MRI bill easily costs 20 times the cost to recoup the investme…

Or more... $2800 would be a cheap MRI in some places... $4K+ I've seen quoted.

It's also no coincidence that companies target physicians to form "imaging cooperatives" where they finance MRI/CT/PET offering recoupment times of a year or less...

and completely by chance have higher by a Std Dev or more ordering of imaging in their private practice...

It's hard, however ethical you are, to not err on the side of sending someone to imaging when you profit linearly off of said imaging.

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

#89
post #64

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

In some parts of the US, I'd be surprised if the specialist didn't own at least a share of the imaging company.

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

#90
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…

> 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.

My primary care physician refused to order a blood draw for a generic std check. I had no cause to think that I was infected, but my partner and I agreed to get screened so we could stop using condoms (she was on birth control). I was quite offended by this overreach. This drove me away from the physician.

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