Right Diagnosis, Wrong Cure

Writing in The New York Times, Sanjay Gupta notes that defensive medicine leads doctors to order tests and procedures that can cause other errors:

In a recent anonymous survey, orthopedic surgeons said 24 percent of the tests they ordered were medically unnecessary. This kind of treatment is a form of defensive medicine, meant less to protect the patient than to protect the doctor or hospital against potential lawsuits.

Herein lies a stunning irony. Defensive medicine is rooted in the goal of avoiding mistakes. But each additional procedure or test, no matter how cautiously performed, injects a fresh possibility of error. CT and M.R.I. scans can lead to false positives and unnecessary operations, which carry the risk of complications like infections and bleeding. The more medications patients are prescribed, the more likely they are to accidentally overdose or suffer an allergic reaction. Even routine operations like gallbladder removals require anesthesia, which can increase the risk of heart attack and stroke.

But Gupta misses the obvious solution: don’t have a medical malpractice system that compensates patients only for adverse events found to constitute “malpractice.”  Instead, have a voluntary no-fault system that compensates for all adverse events — regardless of cause.

Comments (8)

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  1. Ken says:

    I like the NCPA’s solution: get the lawters out of it.

  2. Linda Gorman says:

    No fault did not work well in auto insurance. Premium costs went up.

  3. Kyle says:

    @Ken, I think that can apply to just about everything.

  4. Floccina says:

    Instead, have a voluntary no-fault system that compensates for all adverse events — regardless of cause.

    Interesting idea. If we mostly had no or very high deductible insurance it might come out that way because it would be difficult to collect if the patient was not better after the care (of course it is even more difficult to collect if the patient dies).

    Of course I would settle for loser pays in the legal system.

  5. Dayana Osuna says:

    The last paragraph says it all. Regardless of the cause, Americans deserve a consumer driven health care system that’s willing to care for them despite of the circumstances. Great post!

  6. Devon Herrick says:

    I think the American people in general believe more care is better than less care. Third-party payment tends to reward excessive care. Thus, it is no surprise that doctors engage in defensive medicine. We can blame this on aggressive litigation and that is a mitigating factor. However, I’m not convinced that all defensive medicine would go away with changes in malpractice law. What would have been defensive medicine would become opportunistic medicine. What would drive waste out of the system is a system where doctors compete on price and efficiency is rewarded and litigation is not a fear.

  7. Eric says:

    A lot of what we call “defensive medicine” is coincidentally profitable for physicians and hospitals, so I don’t think fear of malpractice suits is the only incentive driving this behavior.

  8. Otis says:

    I am not at all surprised that 24 percent of the tests ordered by orthopedic surgeons were said to be medically unnecessary. I bet the number is pretty high in other areas of medicine