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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

#91

Post by arkades »

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…

Showing you adhered to protocol is a valid defense. The problem is twofold:

(1) Your insurer will usually prefer to settle rather than go to court, it's cheaper, so fuck your defense.

(2) You still take the reputational and emotional hit of being sued.

People discussing this rarely seem to get that docs are far more emotional about this than the money at risk merits. There are many things in play beyond "I don't want to lose a lawsuit." We really do get very upset about malpractice suits, for many reasons beyond our premiums going up.

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

#92

Post by FireBeyond »

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…

Yeah, not so much. I had a bunch of tests run at the suggestion of my Provider when I turned 40. Insurer decided not all were needed in the first place. So Provider's lab (in house, attached to a hospital) just sent me a bill for $780 instead, for the balance.

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

#93

Post by sandworm101 »

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…

>> No, the patient can sue for whatever reason they want to.

Check your rules of civil procedure. Patients cannot just invent reasons to sue. The case must hit several benchmarks before a doctor ever has to respond, let alone be deposed. Dismissal for failure to state a claim deals with the truly junk lawsuits.

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

#94

Post by sandworm101 »

pc86 wrote: post #44
grasshopperpurp wrote: post #29

Earlier quoted context omitted.

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.

But it does change the math. Where patients do not have to pay for their own injuries, ie under a national health service, they don't need to collect in order to pay for later care.

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

#95

Post by rayiner »

ghein wrote: post #61
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…

Large verdicts have been delivered where no or minimal injury was suffered. As others have mentioned, John Edwards had great success as a lawyer suing over cerebral palsy, claiming that it was caused by actions during delivery. While possible, most cases are caused by other factors such as infections, IVF, or low birthweight. At trial, you have a sympathetic plaintiff with large needs vs a "rich" doctor and hospital.…

> Large verdicts have been delivered where no or minimal injury was suffered.

We live in a country of 300 million people. Every permutation of things that can happen has happened. But that doesn't mean that large verdicts "where no or minimal injury was suffered" happen often enough to account for a significant share of medical malpractice payouts.

There was a Harvard study that looked at this issue pretty systematically, and concluded that the idea of "systematically" "large verdicts against defendants who are unlikely to have done anything wrong" does not fit the data: http://archive.sph.harvard.edu/press-releases/2006-releases/.... Most importantly, claims are about as likely to get denied despite the presence of error as they are to get paid despite the absence of error. (So improving the accuracy of the system would not necessarily decease payouts.)

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

#96

Post by subhobroto »

Fomite wrote: post #87
subhobroto wrote: post #60

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.

> Excess tests result in a higher number of false positives

True, but this is an engineering problem:

1. Just because some tests have a higher number of false positives does not mean all tests have a higher number of false positives

2. For those tests that do have a higher number of false positives, the well educated (and paid) professionals are aware and should have measures in place

Eg: Bloom filters are fantastic datastructures to test membership. However, they have false positives. We can control the probability of getting a false positive by controlling the size of the Bloom filter.

This is nothing new in engineering.

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

#97

Post by subhobroto »

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…

> If states actually wanted to address the costs of defensive medicine, they would do something like create affirmative defenses for doctors who adhered to certain established testing protocols.

Not a bad suggestion but resolving regulatory overhead by instituting regulation is a bit, suboptimal, IMHO.

The better solution is to reduce costs of the tests themselves:

https://news.ycombinator.com/item?id=17620197

In the software world, we have enjoyed significant productivity boost using Git/Hg/FOSSIL vs. CVS/SVN.

Branching in CVS/SVN was so expensive that people rarely do it. It takes me 2 seconds to branch in Git/Hg/FOSSIL

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

#98

Post by forapurpose »

malcolmgreaves wrote: post #6
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…

A patient can sue for any reason. They can be wrong and sue. It's then up to the physican to pay costs for legal defense (i.e. medical malpractice insurance). If the patient is wrong, then the physican can counter-sue. This whole dance is very expensive and, worse, time consuming (which, for a doc, is the ultimate resource). This cost ends up on the patient ad the doc must raise prices to account for the new insuranc…

> the doc must raise prices to account for the new insurance

As I understand it, the portion of additional costs that the doctor eats and the portion that they charge to their patients actually depends on the elasticity of the market for the doctor's medical services. I can't comment on the market for the hypothetical doctor's medical services (in the U.S. AFAIK that market is very complex and opaque, and it probably depends on the doctor, location, and the specific service), so speaking generally about sellers and buyers:

The portion of a cost increase that is eaten by the seller or charged to the buyer depends on elasticity. Computer memory is highly elastic: If your costs go up and you try to increase your price $10/DIMM, then I'm going to buy my DIMM someplace else (unless your DIMMs are very special); a small change in price causes a large change in demand. Superstar developer salaries are highly inelastic: If the developer's costs increase (a new baby!) and they ask for more money, I probably have to give it to them because I'm not going to find a replacement. You see that more publicly with superstar athletes: Cristiano Ronaldo is irreplaceable; the market for his services is at the extreme of inelasticity; he can almost name his price for running around in shorts, playing games.

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

#100

Post by wingspar »

c3534l wrote: post #81
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…

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).…

>why doctors have a skewed perception of the liklihood of being sued (that part is apparently not controversial in the literature).

The correct place to look is not the perception of doctors, but the conclusions from actuarials in the setting if insurance rates.

If it was just a perception bias in the doctors, then it wouldn’t be reflected in the insurance premiums.

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