ANOTHER TEST … PLEASE?

A number of posts back a commenter stated that there are myths about tort reform being bandied about. For those that deny that the legal climate influences the cost of health care, I provide the following excerpt from the ACC News Digest of April 14, 2010:

“The AP (4/14, Nano) reports that ‘substantial number of heart doctors — about one in four — say they order medical tests that might not be needed out of fear of getting sued, according to a’ study published in the Circulation: Cardiovascular Quality and Outcomes. Almost ‘600 doctors were surveyed for the study to determine how aggressively they treat their patients and whether non-medical issues have influenced their decisions to order invasive heart tests.’ Nearly one-quarter ‘of the doctors said they had recommended the test in the previous year because they were worried about malpractice lawsuits.’

HealthDay (4/13, Edelson) reported, ‘That response varied when the answers were broken down according to the intensity of treatment in a given region — that is, the level of health-care services in a region.’ Just ‘12 percent of the cardiologists listed fear of malpractice in the regions of lowest intensity, compared to 35 percent in the highest-intensity regions.’ MedPage Today (4/13, Bankhead) and the Wall Street Journal (4/13, Hobson) ‘Health Blog’ also covered the story.”

Now, having cited the above, I still maintain that a significant amount of test and treatment overuse exists above and beyond that stimulated by the fear of litigation, and reiterate that doctors, patients and the pharmaceutical and device industry can each rightfully claim a portion of the blame.

What are your thoughts?

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2 Responses to “ANOTHER TEST … PLEASE?”

  1. Mark Baird Says:

    Is the fear of litigation a rational fear or is it an irrational fear due to the media and our own exaggerations? After 52 years I have come to realize that the majority of ugliness that we place on things/people are the result of our own exaggerations. Our own exaggerations are driven by our egos.

    A percentage of medical malpractice insurance is driven by investments. http://robertsfight.wordpress.com/2010/03/30/medical-malpractice-premiums/

    How much are lawsuits driven by insurance companies looking at the short term cost. In other words is it cheaper for them in the short term to not fight a lawsuit but rather just pay out a claim thereby making it cheap to bring a lawsuit? If insurance companies were to fight a claim would that drive up the cost of lawsuits and drive out those attorneys that are just chasing ambulances.

    We also tend to believe that juries are out of control but a recent study argues otherwise.

    http://robertsfight.wordpress.com/2010/01/10/maybe-i-am-fighting-for-the-wrong-side/

    And if the following study is correct it would seem that there are some exaggerations in the claims of med mal.

    “Five percent of all doctors were responsible for 43.3% of all medical malpractice payments.(Pg. 42)”
    http://www.npdb-hipdb.hrsa.gov/pubs/stats/2006_NPDB_Annual_Report.pdf

    Again, after 52 years of living I know of no one that brought a lawsuit against a doctor but I do no of one person that should have but did not, a doctor that was close to retirement and did not stay informed of the latest technologies and research for his field of practice.

    • heartheaded Says:

      The fear of litigation is no less rational than the fear of a terrorist attack or crashing in an airplane–the threat is real. However, at any point in time, it is exaggerated. To quote my prior post on the trial lawyers from last September: “NYPIRG, a public interest research group, cites sources stating that in 2004 malpractice cases accounted for only 4% of tort cases and that there are medical injuries numbering more than a million a year, while only about 85,000 lawsuits are filed. This implies that “injured patients rarely file law suits.” The U.S. Bureau of Justice Statistics states that the overall win rate for medical malpractice plaintiffs was 27%, about half that among plaintiffs in all tort trials. Despite this, the World Health Organization reports a per capita expenditure in 2004 of about $6,000 in the United States, much more than most other countries, but there are questions about whether we’re getting “bang for the buck.”

      That being said, it doesn’t change the dynamic. Fear of litigation inflates the cost of health care. You may argue to what extent it’s “exaggerated,” or even the cost of this fear relative to other factors that distort the economics of practice patterns, such as irrational reimbursement algorithms and patient expectations, but it is real. I know of few doctors, including myself, who have not been named in at least one lawsuit in their careers (although they are often dropped in the course of the proceedings, as every doctor involved in the patient’s care is initially named). This, along with the ever-expanding array of government-mandated requirements that must be met does breed a certain amount of paranoia, in my opinion. Like you I’ve seen cases during my career that could rightfully have been brought to trial but were not. Offsetting this are the numerous instances of perceived wrongs that resulted in suits in which I saw no evidence of malpractice. The latter activity still fuels litigation fears.

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