Wednesday, July 1, 2009

Least Common Denominator

I know that many people feel that defensive medicine does not exist but I did a little controlled study to see just what happens. Here is how it works. When a patient comes to the ER, they often get admitted by one of the hospitalist services. These doctors see the patient and are the general managers of their care. Because of liability reasons, if the patient has chest pain rather than work it up themselves and assume the risk, it is an immediate cardiology consult. Headaches, neurology. Diabetes, call endocrine. Pretty soon you have consultants jumping on the patient like fleas on a dog. Of course each of these consultations cost money. If the patient has insurance, each consultant charges their fee. Now here is the study. I looked at whether or not patient who were indigent had more of less consults. The answer was that they had more. The reason was simple. Indigent patients are less likely to follow up and more likely to sue. So, you consult more to make someone else responsible. As one of our ER docs put it, you are recruiting co-defendants. So, it seems that the least common denominator is not money, but liability.


SeaSpray said...

Throckmorton...I thought it was a given that defensive medicine exists and anyone who knows anything about the medical profession knows that.

I don't understand how recruiting co-defendants helps the ED doc or any doc that would use this strategy. If a patient is going to sue... won't they just name everyone involved in their care? And so everyone is sued?

It bothers me to think doctors look at us patients as potential lawsuits in stead of just their patients. I know it can't be helped and you need to be vigilant... but I think it is sad.

SeaSpray said...

Throckmorton! Just wanted to tell you that I caught the tail end of an interview on the Sean Hannity's radio show yesterday and he was talking with this Dr..(orthopaedic I think)calling him Dr John (I think) (taking shower so my attention wasn't 100%), but.. what I did hear this doc say...speaking from a doctor's heart, experience/perspective sounded so good. i was hoping that people that are in power making these health care decisions were taking notes. (I doubt it- not for good anyway, then again.. we never know how our words will impact a decision.

He just made so much sense!

Sean said he was better at talking about it then he was and told the guy to stay on the line and said he'd like to have him on TV as a guest.

We NEED more doctors to speak out!!!

When I have time... I am going back into Sean's website and direct him and his staff to the medblogs again. maybe they are already perusing them.

He let this doctor talk without interruption for quite awhile. I could imagine most Docs in America that heard it right behind him in spirit.

Wish I heard it all but he did talk about billing and tort, oh and how elderly people who are not good candidates for replacement surgery come in to get shots into the area (forget what kind)to help with pain. It used to be they could do it when needed, then reduced to twice a year, but under new plan their options would be severely limited... because of cost to the system.

I definitely hope this doc goes on his show and gets more doctor interviews. I just do NOT, do NOT trust this current administration to put a new health care plan together.

This doc did say our system was a mess. Well... I am not telling you anything you don't already know. Just got excited to hear such an in depth interview with a physician telling it like it is.