Unnecessary testing and prescribing is often the first example that comes to mind in discussions of defensive medicine, but Stuart Turkewitz, M.D., explains why needless hospital admissions, especially of older adults and those with chronic medical problems, should also be seen as a prime example. Just to lend interest, Dr. Turkewitz, an internist and geriatrician, contributes the views as a guest blogger at the New York Personal Injury Law Blog, published by his lawyer brother Eric.
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It is not just the admissions that drive up the defensive medical costs but what happens once the patients are admitted. The classic is the elderly patient who comes in because of flu. While they are in the hospital, their primary care doctor or the hospitalist is able to manage thier whole admission. Rather than doing this, every internist knows the first question a plaintiffs attorney will ask is “Why didn’t you consult a specialist?” So, the internist consults everyone. Pumonology for the pneumonia, endocrine because the patient has diabetes. In the course of the admission every medical problem that the patient has to which the internist can be held accountable will be consulted out. You end up with 10 consultants and ten seperate charges. The family is happy because they think this is better care, and guess what, they are not paying for it, Medicare is. Now on top of this, this consult culture has been taught to our residents and medical students so they think this is the way medicine is supposed to be practiced. For those that think this is all a money grab, the same consulting practices occur for the uninsured as well. For those of us who are called to consult, we just say that we have been recruited to be a possible codefendant.
OK, so let’s assume all this is true. And let’s look at the caps on damages which are the proposed reform. We have had multiple states with at least 10 years of caps and we have lots of states without.
Are those WITH the proposed reform any less likely to admit the elderly than those without? And are those states with the reform spending less on elder care as a result?
Ought to be an easy thing to show one way or the other. If the admissions don’t change, and the cost isn’t any cheaper, then perhaps we need to look at other possible reforms.