“I’m Sure It’s Nothing, But…”

Five words that are at the very core of the health care crisis in America.  Six more?  “Out of an abundance of caution.”

See, the problem with these words are that the Doctor who is telling them to you, based on his experience and knowledge, is telling you that there’s nothing wrong with you.  Whether it’s the stomach pain you went to see a GI for, or the chest pain you went to a Cardiologist for, these doctors know (not guess, know) that you don’t have a serious problem.  That’s why you go to them, because they know that chest pain that’s cardiac related is general tightness and crushing pain in the entire chest area, not sharp localized pain in one spot.  They know that a 29-year-old male that doesn’t have high blood pressure or high choelsterol isn’t likely to have heart disease.

But.  There’s the key word.  But.  Right or wrong, if the doctor let the patient walk out of the office without any further investigation, and something that was otherwise not-knowable and a one-in-a-million chance actually happens, there will be a process-server at that doctor’s office dropping off some bluebacks.  So the doctor, in order to cover his own ass, and since the patient has insurance and won’t pay for it directly, orders some unnecessary tests “out of an abundance of caution.”  See, the important thing to note here, is that it’s not your health that he’s being cautious about, it’s his liability.

So now what?  Well, the doctor orders the expensive test.  You go for it.  Maybe you miss a day or a half0day of work, so your productivity suffers.  The staff at the hospital now has to slot you in for an appointment, possibly making someone else, who really needs that test and the attention of the medical staff wait, and then they bill your insurance for it.  The hospital and doctor become over crowded, people have to wait for procedures, and the insurance pays out a couple of thousand unnecessary dollars.  Your premiums go up, health care and health insurance prices go up, and getting adequate health care becomes harder.

Why?  Because the medical malpractice law suit world makes that necessary.  Because the doctor has to protect himself, so he introduces vast inefficiencies in the market.

Now, I’m not sugegsting that the medical malpractice world of litigation be eliminated completely (my doctor father and brother would like that, I’m sure), butI’m just pointing out that it’s an inefficient system (in terms of allocating responsibility for injury and harm) and it creates even bigger problems and inefficiencies in the provision of health care at all.  Any reform to the system, including trying to make health care affordable and available to all, has to address this problem.

What the best way to address it is, in my opinion, is the subject of another post.

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7 responses to ““I’m Sure It’s Nothing, But…”

  1. Excellent post. I think I agree with pretty much everything you wrote. No, I don’t think elimination of the malpractice lawsuits is the answer, its how we go about it. The current system just doesn’t work fairly or correctly. But as you said, other ideas are for another post altogether.
    Another factor that I think plays a big role, is patient retention. That is, alot of patient’s have an idea of what treatment or test they want from a doctor. For better or for worse, if they don’t get that treatment they will look elsewhere. So, alot of doctor’s will also order tests or treatments that they ‘know’ are unnecessary, so as not to alienate patients. The solutions to this problem? Another post.

  2. I think the problem rests squarely on the state of malpractice and tort reform. It isn’t that doctors decided one day to cover their own asses; society — our litigious society — has molded a system whereby we have demanded that our doctors perform these unnecessary tests.

    That is to say, plaintiffs sue many reasonable doctors who perform more than reasonable care (such as the “doctors [who] know (not guess, know) that you don’t have a serious problem” and therefore don’t order an unnecessary test). They put those doctors in front of juries. Every time a jury finds that these doctors acted negligently, society instructs the entire medical profession to act with an even smaller margin of error and to skew the cost/benefit analysis even further in the direction of adding more costs and erring on the side of caution (even when the costs are great and the potential benefits are small).

    That’s not to say that there isn’t an honest-to-goodness need for real, legitimate malpractice lawsuits. Every profession has its bad apples and bad actors, and I’m not suggesting that there isn’t a place for malpractice lawsuits when they are called for. But the pendulum has swung much too far, and the negative effects are widely felt.

  3. General R. Blie

    Thank you, Noyam for this oh so informative post. This just in – the US medical system has problems. In other news – Bears crap in the woods.

    This post won’t get interesting until we discuss solutions.

  4. General R. Blie

    I see this as two issues: Medical malpractice litigation and basic cost/allocation of services. I have potential solutions to both of these issues.

    Medical Malpractice:
    I don’t we should eliminate malpractice claims or, as some have suggested, impose the cost of the lawsuits or punitive damages on the plaintiff for suits that have no merit. (If they are truly frivilous, the court can already impose sanctions on the plaintiff, or more likely, his lawyer.)

    I think the best solution is to have lawsuits reviewed by a special magistrate, who is a medical expert (or a panel). In most of these cases, the question is whether the doctor was reasonable. In malpractice (I believe), the standard is that of the profession. As such, a gatekeeper function performed by the profession makes sense. (The standard for going to trial could be lower – i.e., if there is a reasonable argument that the doctor did not meet professional standards.) (This is simila in concept to the Grand Jury in criminal cases.)

    Drawbacks – This would obviously face opposition from lawyers, who will inevitably argue that the doctors will be inherently biased against bringing cases. But I don’t think its any more biased then the current system, in which the lawyers act as gatekeepers and is inherently biased to bringing cases. At least in this case, 1) the gatekeeper has the requisite knowledge to make an informed decision and 2) if it is biased, it is at least biased on the less costly side of the coin.

    Making the medical system more efficient:
    I think there are a lot of cost savings to be had before we start encouraging doctors to make cost/benefit analysis of ordering tests/procedures. Personally, I want my doctor to order a test for the one in a million possibility (at least for my family, maybe not for others.)

    However, we can introduce other savings first. Electronic medical records is the obvious one. It will eliminate cost of miscommunication and double testing when people do opt for second opinions. In addition, I do not believe in socializing medicine, but I would be more willing to consider semi-socializing pharmaceuticals. I would not have a problem with the government setting drug prices while at the same time eliminating the time limit on drug patents. Drugs would be cheaper if the company knew it would have a longer time frame to recoup its R&D. In addition, it would encourage companies to work on drugs to help less common ailments. (4 companies have ED drugs, simply because it is a good seller. If only one company could hold the patent , the other companies would have spent that money on other drugs.) Finally, ban medical advertising (except maybe in medical journals or other places targeted to physicians.) I think one of the biggest reasons people demand more tests and more drugs is because the TV tells them they do. I agree there should be WebMD’s and places to get information, but they should not be allowed to be funded in any way by drug or medical companies (maybe they should even be non-profit.)

    If you add these to the savings from the lower litigation costs, medical costs would be more reasonable.

  5. I think those are all good points, and agree with almost everything, except that I’m not sold that drug companies would lower prices if they held onto their patents for longer. And I don’t know that you’d get drug companies to stop making ED drugs and focus on those less common ailments.

  6. Who said everything I write has to have some sort of massive chiddush at the end? Jeez.

    This brought on by a recent experience of mine (in case anyone was unable to ascertain that from the example I used), so I wanted to write about it.

  7. Pingback: Fixing Medical Malpractice « The Noy G Show

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