Friday, February 19, 2010

Defensive Medicine Almost Kills

I have heard attorneys try to argue that defensive medicine does not exist or that it is not prevalent, I have even heard them that the reason doctors order so many tests is because they make money on them. I would love to have those attorneys spend a few nights in the ED and see the reality. First, we dont get paid for the test, we dont get paid for the results. We do pay if a year later we have to face a lawyer who asks why we didnt order the test. This has got so ingrained that our medical students and residents dont ask what tests should be run but what tests can be run. So it was the other night. A patient came in with what appeared to be a classic migraine. One that they had before. The doc ordered the standard tests, (doesnt matter if they have insurnace or not, because it doesnt matter to an attorney), one of the tests was a uncontrasted CT of the head. The intracranial part was normal but there was some question of a tortuous carotid vs a skull base lesion. Since he could not rely that the patient would follow up to have this evaluated, the doc ordered the contrast scan of the skull base. The patient then had a bad reaction to contrast and went into shock and had to be resuscitated back in the ED and ended up intubated.

So, was the doc ordering the tests to get money? No, we dont get paid by the test. Why was the second scan ordered, CYA? The result of the defensive medicine? The patient got intubated, spend time in the ICU and had a MI from the epi given during the contrast reactionn


SeaSpray said...

Hi Throckmorton - The poor patient! I hope he pulled through.

I wish you docs could take medicine back and work it like you know in your heart to do from years of training and experience.

I don't blame docs at all for the cya, but am bothered that the patient is the one who pays the ultimate price with adverse reactions such as in the case of this patient.

I would also say personal financial cost to the patient is another consideration and then we all know to the system as well.. particularly if pt is uninsured/mdcd/mdcr.

Talk about a bad shift for the staff though ..yikes.

Throckmorton ..I think unless people walk in your shoes they just don't understand all that doctors do go through, put up with,..the responsibilities and the risks and I also think the majority of non medical population probably think you make tons of money (I'm sure you all do alright ..even with cuts) and drive great cars, living in large houses. I think that is the public perception and the suing ones see you as a potential cash cow. But they just don't have a clue about what you really have to do or how hard you work and the hours you put in ..not just between facilities and clinic and administrative but continuing education. Do I have that right? :)

Then attorneys ..well maybe they should have mandatory ED time to have a better appreciation of how it all works. But I think they really do know and don't care because they are coming at it from the other side of things.

SeaSpray said...

P.S. And there is something docs an other med staff get that the average person does not. What must be the most rewarding and spectacular feeling when you save a life and or truly help relieve someones suffering.

Can't put a price on that. I know topic, but just wanted you to know (I know you know), that you do make a huge difference in people's lives.

Where would we be without doctors? I know it's necessary to have laws that protect the patients and the ability to sue if they are harmed by a Dr Mengele type, but I also think you deserve to be treated with more respect and ins companies should not be allowed to make the kinds of cuts they do ..and that is for both doc and pt.

Gosh it's complicated.. but needs to be fixed.

Medical Negligence Claim (Australia) said...

As a clinical negligence lawyer really appreciate the insight on defensive medicine. Keep up the good work.