Justinian Lane

What about defensive medicine?

Tort reformers commonly complain that "defensive medicine" - performing unnecessary tests and procedures to prevent litigation - is driving up the cost of medicine. A new study by the Annals of Internal Medicine found that the failure to order appropriate tests and procedures was a factor in almost 33% of malpractice cases the researchers studied.

"PHILADELPHIA -- Basic errors made by doctors, including tests ordered too late or not at all and failure to create follow-up plans, played a role in nearly 60 percent of cases in which patients were allegedly hurt by missed or delayed diagnoses, a study found.

Researchers in the study, published in the Annals of Internal Medicine on Monday, reviewed 307 closed medical malpractice claims, 181 of which allegedly involved diagnostic errors that ended up harming patients. A large majority of those cases involved various types of cancer.

While researchers acknowledged that most claims involved several factors, they said major ones included mistakes by doctors: failure to order appropriate diagnostic tests (100 cases); failure to create a proper follow-up plan (81); failure to obtain an adequate history or perform an adequate physical examination (76); and incorrect interpretation of tests (67)."

30% of the cases they examined involved the death of a patient.

Doesn't it seem foolish to be concerned with how much money is lost by unnecessary testing when so many lives are lost when necessary tests aren't run?

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Posted at 10:06 AM, Oct 06, 2006 in Medical Malpractice
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There are two problems with the defensive medicine argument.

First, if the test is irrelevant to the patient's condition, it would not serve as a defense to a malpractice case anyway.

Second, when you start talking about specific circumstances and specific tests, the argument falls apart. This argument only makes sense in the abstract, not in the particular.

The recent article on this subject was based on doctor questionnaires, not a review of the medical records.

while I agree completely with your position Justinian, this is a response to a nonsensical argument by those proposing reform. I have yet to hear the reformers address prevention of medical injuries, toxic exposures, or exploding gas tanks.

It might be interesting to post some of the documents of corporate negligence or worse, as you did with the Pinto memo.

The central issue is: "What do we do about injuries?"

Most importantly: "How do we prevent them?"

If you can get a tort reformer to address the prevention issue, I will buy you lunch.

Posted by: lee tilson | October 6, 2006 10:35 AM

Organized medicine has a self-serving, socialist agenda. It has no credibility. Don't bother quoting any propaganda put out by them. It is biased, and has no validity. Let's say, malpractice takes out 2% of the health budget to finance the obscene lifestyle of the plaintiff bar. Defensive medicine in response to this unwarranted threat by lawyer criminals takes out 10% of the health care budget. The health sector thus has a 500% return on cost of malpractice. That is on the front end. When the plaintiff lawyer says, make the plaintiff whole with a ton of money, what is that? It is medical care, for a long time. So medicine gets its money back on the back end. This scheme makes cocaine dealing pale in profitability. It carries no risk, is guaranteed into perpuity, and perfectly legal. The two professions do well.

Meanwhile, the public receives no value for this 12% loss to theft by rent seeking professionals. Let's say, the health budget is $1.5 tril a year. These thieves have taken out $180 billion, and returned no value to the public.

For $180 bil a year, one could purchase top of the line health insurance for 30 million uninsured people. The doctors would still make their 10%, but in a useful way. The lawyers would be cut out. They are members of a criminal cult enterprise and deserve to go to Federal prison, anyway.

Beyond the money is something bigger. It is the coverup by the medical profession forced by the nearly uniformly bogus lawsuits being filed. Once these bogus lawsuits are ended, the cover up would end by force of insiders who know where all the corners are cut. There would be airline crash style investigations of medical errors, continuous improvement of the system, and zero tolerance of mostly silly miscommunincation and other mistakes. This would make accountability far more painful and inescapable to the doctors.

JL, you sound young. Come 30, plan on the failure of an organ every decade. Then plan on a life threatening mistake every day you are in the hospital, numerous lesser errors. Or you may decide to have a child. Same deal.

You want this mess settled soon for your personal benefit.

Posted by: Supremacy Claus | October 6, 2006 8:53 PM

Supremacy - you definitely have some strong opinions. Have you seen the GAO study that shows malpractice costs amounts to less than 1% of the total healthcare expenditure?

Posted by: Justinian Lane | October 7, 2006 6:11 PM

The direct cost of malpractice insurance is less than 1%. That doesn't include (1) the expense of self-insurance; or (2) the indirect costs of malpractice, including (a) defensive medicine, and (b) health-care shortages caused by doctors being driven from the market. That's a bigger number, and it's disproportionately placed in important areas like OB/GYN, neurology, and emergency medicine.

Posted by: Ted | October 7, 2006 11:26 PM

"you sound young. Come 30, plan on the failure of an organ every decade. Then plan on a life threatening mistake every day you are in the hospital, numerous lesser errors. Or you may decide to have a child. Same deal. "

Is this supposed to mean that Justinian, because of his age, has more or less to invest and care about in this debate?

How does age change the equation???

I think that the youngest child, and the oldest senior, has an equal stake in this debate.

Posted by: john | October 8, 2006 1:44 AM