Saturday, September 19, 2009

Medicolegalspeak Reports

Oh, I miss the days when you got a radiology report that said, "fracture right 3rd rib, no pneumothorax". Because of frivolous lawsuits radiologists have learned to be vague, noncommital and to pass the buck of possible litigation. So now you get a 2 page report that says "linear lucency in right 3rd rib, clinical correlation recommended, underinflated lung fields can not exclude underlying intersititial disease and or masses. CT recommended for futher evaluation, if condition warrants." along with several other paragraphs of lawyer imposed legalmedspeak. The radiologists are not the only ones who are protecting themselves from possible lawsuits. Pathology is right there. Once a lymph node biopsy they used to say "node consistent with reactive process". Now they give the ratios of the B and T cells and dont even bother to tell you what they think it is, you have to decide and therefore assume all the responsibility. Aint it great. We think we are the surgeons but the radiologists and pathologists have learned to amputate themselves from the disease of "joint and severable lawsuits".


SeaSpray said...

I've read some of those reports and know what you mean. (Not that I understand all of them :) It's too bad things just can't be more simplified.

I wonder... would tort reform improve these things? Probably not.

Regarding pathologists... isn't it their job to be definitive about the dx? Well..I suppose I could ask that about the radiologists too. docs really have to not only know your own requirements... but have some serious knowledge regarding these other medical specialties... which I guess you get some of when you are in training. ? That's where you decide if you want to specialize in a certain area and then pursue it. ?

Anyway.. so what you're saying is... they lead you up to the obvious conclusion... but won't actually commit in writing. Wow. I'm guessing they clarify via phone if you have questions.

SeaSpray said...

I had a CT I didn't need because of a stupid radiology report (and me).

Well... my doc didn't think I needed it and while I was with him in the exam room he called the radiologist who also said it was incidental.

I had my 1st abd CT to rule out GI problems (none found)and there was a nodule reported at the base of one of my lungs. PCP said that with today's modern technology..they find all kinds of incidental findings (have to report it)that aren't anything to be concerned about and that if I ever had pneumonia or bronchitis..those conditions could've caused that. (I did)

But... About 8 mos later I just had to know if there was a change and so had another CT and no changes. (I've had so many more abd cts and never thought to ask if they saw that nodule)Hmmm.. well I don't think about it and do believe it was just scarring or whatever from one of the respiratory things. I am guessing the pneumonia when I was 13.

And you know what? I asked the tech setting me up for the CT how often I'd have to get this to check on the nodule? he said every year for the rest of my life! pcp countered that and said he did not believe that was anything to be concerned about and so I really did let it go. (think it was around 2001..not sure)

My point in writing all that is..*if the radiologist had put in writing that he did not believe it was anything to be concerned about.. I wouldn't have been concerned and ultimately insisted on another ct.* And no one ever told me that getting these tests posed any risk to the patient or I would not have gotten the second one.

And actually.. the only reason I ended up going to the gastroenterologist is because I went to my gyne doc because I thought I had endometriosis (extreme pain during the expected time it would occur), but he said I should rule out gastro first. If not that..he'd put me on a med.

So.. I actually has 2 ct's I didn't need early on.

I've learned a lot from your blog and others and I can see now where certain cts were absolutely necessary and others weren't and now I understand why they do them.

But the patient is the one who is potentially hurt... caught in the crossfire of physicians trying to avoid lawsuits.

Oh.. and I was right about the endometriosis. Gyne doc died before I went back, but I told another doc the symptoms and without sending me for any tests he immediately said "You have endometriosis!" He immediately dxd it... just like I thought in the first place.

SeaSpray said...

Okay Throckmorton.. I'm sorry for the long comments. This post is a hot button for me. :)

So..after reading all these things in medblogs.. I understand how it works and will question and hold my ground if something doesn't seem right.'s a double edged sword in that a little knowledge can be dangerous and scare a patient..well..this patient unnecessarily. And I don't want to go against my docs..that is not comfortable either.

It really bothers me to think that the docs I respect and like so much, could be looking at me as a potential lawsuit and thus order cya testing or just be concerned I'd sue for some reason.

I appreciate the good docs so much! I just would n-e-v-e-r do anything to hurt them. They are the ones who have been helping me..especially one... because of the chronic nature of the condition. He has done so much work and has been there through thick and thin with me.

You are between a rock and a hard place sometimes and all you can do is your best. I know you all have to look out for yourselves, the practice, family, reputation and all the things that could be compromised in a lawsuit... and then after reading Whitecoat's enduring 6 years to go to trial.. how awful!

I just want my docs to be straightforward with me. Tell me their honest opinions. You what they were trained to do and forget the cya tests, etc. And don't worry about offending me either. I am going to them for their expertise.

Conversely... I wouldn't want them to hold back on testing because they think I'm squirrelly about radiologic testing... if they really thought I needed it.

I am so very grateful I have a doctor who understands and is working with me on this..but knowing the type of doc he is..I also have no doubt that he will say what he thinks and tell it like it is.

If doctors aren't willing to commit to do what they know ... ironically... it really is the patient who loses ... when they are the ones the doctor wanted to facilitate healing in... in the first place.

How do you all deal with this kind of pressure..always having to be on guard? It seems that the buck really does stop with the treating physician... unless you flea the dog. See I'm learning here. ;)