Comments on: The health costs of defensive medicine

By: Walter Olson

Walter Olson — Wed, 05 Mar 2008 12:00:35 +0000

It's also worth pointing out that the problem of needless or avoidable CT and MRI scans has been getting a fair bit of discussion at the medical blogs lately, e.g. White Coat Rants, GruntDoc, and KevinMD.

By: throckmorton

throckmorton — Tue, 04 Mar 2008 09:26:26 +0000

“Defensive Medicine” is one of those terms that has its meaning swayed for the benefit of whoever is trying to prove a point. The problem is that we have no good way of knowing what is defensive or not. To determine what is defensive we have to look at what sensitivity and specificity we will accept. The classic example is a headache in the ER. With a good clinical assessemnt and time you can be sure 99% that this is a migraine. Is 99% good enough? Not in a court of law where one missed out of 1,000,000 will cause a huge lawsuit. So, you order the ct scan and expose the patient to radiation, if that is negative there is the MRI and MRA ($5600). Can we use research to determine what the exact cutoffs should be for a scan or not? Sure, this is easy to do but then how will attorneys sue for the one in a million that occurs.

“Defensive medicine” is real and represents a huge part of our outpatient studies and medical expenditure. Unfortunately our courts show us that there is no room for reason, science and statistics. Until we as a society can determine what we will and will not accept in terms of sensitivity and specificity, more and more tests and radiation will used to treat attorneys instead of patients.

By: OBQuiet

OBQuiet — Tue, 04 Mar 2008 09:12:59 +0000

Ted, Ted, Ted,

You are clearly living in the dark ages(with all the extra RADs, things should be glowing soon).

I have a modest proposal.

The clear econimic solution is to create a balanced incentive for doctors. Simply sue them every time a CT comes back with out finding anything! Cost of long-term monitoring like all those other cases that the lawyers are finding so profitable.

This will create a proper disincentive to offset the the incentive to perform the test caused by excessive lawsuits. It will allow Doctors to once again call for tests that they feel are needed without worrying about the liability issues. They are liable either way! The patients will see better long-term outcomes, doctors are once again free to practice medicine and , best of all, the Lawyers all get paid!