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Front Page » April 23, 2009 » Focus » Practicing defensive medicine: The truths and consequences
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Practicing defensive medicine: The truths and consequences


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By RICHARD SHAW
Sun Advocate publisher

A lot of people envy physicians for reasons that they see from the outside. Money, stature, education, prestige, etc.

It is always easy to see the good side of a profession from the outside, because the details are easy to lose when one is not looking closely. But physicians have a tougher life than most people know. They struggle with many of the same things the rest of us have to deal with as well as their relationships with patients, many of whom are very sick.

And think about it. For most people, if they make a mistake in their profession, it may cost the firm a customer, create a bad image in the public's mind, or cost the company some money. For a physician, the cost of a mistake can be resulting physical and mental pain for someone, even death. How many times a day does a person in another profession make a mistake; how many times in their career do they not live up to that optimum performance?

Yet people hold doctors to a higher standard. What is an acceptable rate of miscalculation for a physician; one time in a 100? One time in a million? No one seems to be able to answer that question except through the courts.

Depending on the kind of physician a person becomes determines the direction for most of his or her life. For the last 20 years the move to specialties has become a real issue in the medical profession. It is estimated by the American Medical Association that only five percent of those going into medical school today go into what is called general or family practice.

The family doctor used to be the most common doctor in the phone book, but times have changed, largely based on financial considerations. It is hard to tell someone who is going to graduate from medical school with eight to 10 years of hard education and hundreds of thousands of dollars in debt to finance that training that they need to go into what is the lowest paying job amongst physicians; family practice.

And going into something other than general practice has one more thing going for it too; general practice doctors rank right up there with the doctors that are sued the most. The top list for being sued, along with the family doctor, are gynecologists, neurologists, emergency room physicians and even radiologists. General surgery and orthopedic surgeons are right in the same vicinity.

Doctors fear lawsuits because it can damage their business, and while many seldom have to pay anything out of pocket directly to a patient because they have insurance, their rates can be raised as well. On top of that lawsuits take up a lot of valuable time, and certainly energy. They are also mentally draining and stressful as well.

According to wrongdiagnosis.com over 50 percent of doctors get sued sometime during their career, and 10-20 percent of those cases reach the trial phase.

The problem also comes from court rulings which skew the factors in a suit or whether the lawsuit is even viable. For instance, according to the Wall Street Journal in 2007 the Massachusetts Supreme Court ruled for the plaintiff in a case concerning the death of a 10 year old boy in traffic accident, caused by a man who fell asleep at the wheel of his car while he was on prescription drugs. The court said the man's doctor had failed to adequately warn him of the dangers of the side affects of the drugs, and that contributed to the fact the man lost control while driving his car.

An odd case to be sure, but still it shows how court proceedings can go and it alarms everyone connected with medical practices.

So enter defensive medicine; the kind that takes care of all alternatives so that no mistakes are made.

In actuality, defensive medicine can be construed as a deviation from sound medical practice by some. A 2005 survey by the Journal of the American Medical Association says that 90 percent of doctors admit that they practice defensive medicine, but many find it cumbersome and troublesome as well.

There is also more to it than what appears on the surface. Of course everyone knows that doctors may order tests that are unnecessary to be safe, but some may also avoid taking high risk patients or they may not perform high risk surgeries either. That is truly a disturbing trend that ties into the fact so many are not going into facets of medicine which require those kinds of decisions.

A family physician sees all kinds of people; nothing is spelled out for him or her. The patient walks through the door with a variety of complaints, all of which do add up to something, but that something can be elusive.

Or take the emergency room doctor. A person can come into a hospital for everything from a cold to a broken arm to life threatening injuries. In this day and age the emergency room doctor often becomes the family physician due to insurance problems the patient may be experiencing.

In an article by Dr. Richard G. Roberts (Seven reasons family doctors get sued) featured by Family Practice Management, he says that there are many ways doctors and hospitals can let patients down, beginning with too slow a diagnosis. He says that first thing a doctor is responsible for is to keep a patient from harm or injury, but that they should secondly work toward avoiding malpractice claims. He says to do this a physician should follow their patients' complaints to a full diagnosis, prepare themselves completely before performing any kind of procedure and finally, know when it is time to consult with a colleague or when to make a referral of the patient to someone who may be more skilled in that patient's problems particular area.

Roberts also pointed out that there are a lot of myths about malpractice including the following:

•Lawsuits against doctors is a new problem. Actually the first recorded lawsuit concerning malpractice took place in 1794. In addition doctors sometimes refused to treat injuries incurred during the Civil War for fear of being sued.

•It's about money. Most suits take place because the patient or their loved ones don't want to see a reoccurrence of the problem they faced and they want someone to be accountable.

•The number of lawyers is the reason for the high number of malpractice suits. Actually it is the number of doctors that exist that predicts the number of suits.

•Frivolous suits are the cause of malpractice problems. Roberts states that a GAO report shows that less than 10 percent of malpractice suits are "insignificant." Actually frivolous lawsuits are uncommon because most concern serious problems the patient has.

•Doctors can do little to prevent suits. Not true; doctors who have a good bedside manner and relate to their patients have much less chance of being sued.

•Court cases favor the plaintiffs. That is not the case; in 2002 for instance doctors won 62 percent of the cases that went to trial.

•New laws concerning limiting suits is good. Roberts says that is not true; some are actually make situations worse.

Of all the problems that a lawsuit causes for a physician, probably the worst is not money, but emotional stress. When a summons arrives physicians often feel a variety of emotions; shock, disbelief and denial. Many have no idea it is coming and their world of control is suddenly gone and in the hands of others, including lawyers and insurance companies. Knowing that their professional reputation is in question is very hard, and very traumatic.

Next comes the discovery period which in some instances can last for a very long time. Interrogations, investigations of records, charts and requests for written and then verbal statements during the deposition are tough steps to take. Often doctors are thinking about their status as a professional, and in their emotions forget that good doctors do get sued and that sometimes truly incompetent doctors do not. Often physicians begin to make up the feelings by working more and harder, but this can be detrimental to family and health.

While the discovery takes a long time, the settlement or trial can seem to be much longer. Doctors are often in a dilemma about settling, even if they know it may be the easiest action. Because settlements are often listed on the National Practitioner Data Bank, many worry even more about their reputation.

Even when the whole thing is over with doctors sometimes have problems handling the emotions of the situation for a very long time to come. Most enter the medical profession because they want to help people, and the possibility that one may have either harmed or damaged a patient in some way is a tough issue to resolve. At this point self-doubt about professional abilities can settle in regardless of the outcome of the case.

People in general are sued everyday. Often the suits have weak ground or are just a shot in the dark. For most people as emotional as it is, it is not about what they do for a living. For doctors it is a central part of their being.

As laws change, for good or for bad, it is obvious the idea of suing doctors for malpractice will not go away. While no exact statistics exist to say that defensive medicine to cover a doctors back does cost insurance companies and of course the public more, it's hard to imagine it doesn't. Tests to check for hard to detect problems will always be run for both analytical and defensive purposes.

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