A few months ago I posted about CYA—Cover Your Ass—medicine being one reason why too many diagnostic tests are ordered and health care costs are high.
CYA medicine is when the doctor or doctors are pretty sure what your problem is, but they order extra scans and x-rays and blood tests anyway because “failure to diagnose” is one of the leading causes of medical malpractice suits. They aren’t going to take any chances, and who can blame them?
Related story from KevinMD: This is why doctors practice cover your ass medicine
Besides, they don’t pay your resulting medical bill, so there is little down side for them in ordering expensive tests.
Related post: Atul Gawande – Overtreatment, “Overkill”
I just read the results of a study that supports what most doctors know—the more tests they order, the less likely they are to be sued.
To protect themselves, doctors often order tests and procedures that aren’t medically necessary, pushing up the cost of every hospital visit. And a new study found that when the bill is higher for hospital admissions, the overseeing doctor is less likely to be sued.
They found that physicians with higher costs — presumably because they ordered more tests, procedures, and consultations — were accused less often of malpractice in the following year. Doctors who averaged costs of about $20,000 for each hospital admission had a 1.5 percent chance of litigation, while the rate was only 0.3 for those with average costs of around $40,000.
This finding worries some doctors, who expressed concern about whether medical decisions are being motivated more by legal questions than by patient needs.
“If you order every test known to man … you may reduce the likelihood that you will get sued, but it certainly isn’t the best medicine for people, and it certainly isn’t the most cost efficient,” said Dr. Alan Woodward, an emergency medicine physician in Concord, Mass., who was not involved in the study.
Over 60 percent of American physicians say they practice this kind of “defensive” medicine. But researchers had never studied whether this behavior actually limited a physician’s exposure to malpractice liability.
This study highlights one the the major conflicts in today’s health care systems—a lot of screening and diagnostic tests are being done either for profit or for protection, not for the patient’s (or society’s) best interests.
I have many friends who are physicians and they don’t like this reality any more than the patients. They don’t want to order extra tests, but believe they have to, either to protect themselves or at the order of their bosses, the hospital corporations.
Physicians in this country have long lobbied for tort reform, a change in our medical malpractice system that is fair to both physician and patient. As it stands now, patients can be rewarded millions of dollars for “pain and suffering”, which is pretty subjective. These rewards are in addition to any rewards to cover medical expenses and loss of income.
Lobbying just as hard to keep the status quo are the trial lawyers; they receive a pretty big slice of those multi-million dollar settlements and judgments.
What’s a patient to do, especially one—like me—who doesn’t want to be exposed to the risk or expense of unnecessary health care? I really don’t know the answer.
The best I can advise is to be informed. Learn more about tort reform and what your state’s lawmakers are saying or doing about it.
And become more informed about the latest evidence-based guidelines for screening and diagnostic testing. The website Choosing Wisely is a good place to start.
Related post: Save money by Choosing Wisely