From: sbharris@ix.netcom.com(Steven B. Harris)
Newsgroups: misc.consumers,misc.consumers.frugal-living,talk.politics.medicine,
	sci.med
Subject: Re: MacDonalds verdict was VERY justified WAS Medicare and Bret's
Date: 31 May 1999 05:32:16 GMT

In <3751F2CF.96ADF9A0@Mindspring.com> Jim <JDBarron@Mindspring.com>
writes:

>They can't make a case out of thin air Steve.  If you don't commit
>malpractice you are relatively safe.  If you meet acceptable standards of
>medical care, they can't get you.  TRY it! (NOBODY is totally safe in a
>system so heavily corrupt).

  Nobody is safe.  I have yet to be sued, but I'm relatively young,
with 25 years more to go, at least.  An estimated 1 out of 3 American
doctors will be sued for malpractice in their careers.  Do you think 1
of 3 don't meet acceptable standards of medical care?  That doctors in
other Western countries are many times better than American doctors?
You probably actually do believe this, in which case there's no use
arguing.

   But you ducked the question when I asked you why American
professionals of all kinds from lawyers to architects, are many times
more likely to be sued for malpractise than their counterparts in other
countries.  Tell me why half the price of a stepladder or a light
airplane should be liability insurance for the company that sells it to
you.  Do you enjoy paying that money?  That when you buy a stepladder
you are paying the medical bills of people who do stupid things with
stepladders, not for people who have stepladders break under them or
something obvious.

   You were complaining about the cost of American medical care not
long ago.  You are clueless as to the connection here.  Drugs cost more
here.  Medicine costs more here.  A lawyer costs more here.  An
artitect costs more here.  Each of these things has reasons.  Until you
step away from medicine and see the big picture, you'll never figure it
out.

   It does no good to make industry "accountable" for their customers'
stupidity, because there's very little they can do about it.   All
those stickers on a stepladder or a box of toothpicks telling you how
to use them are not really an answer.  There's something very wrong
with a society that needs instructions on a box of matches or a plastic
bucket.  You cannot make things foolproof because fools are so
ingenious.  No truer thing was ever said.

   And that's not even the worst part.  The worst part is what you
don't see.  The products that are never developed, or developed too
late to help people, because everyone is afraid that somebody will get
hurt, and sue.  In the case of vaccines it got so bad that without
DIRECT government intervention to hamstring the civil litigation
process, you would not today be able to buy a dose of vaccine in the
United States for love or money.  The very last couple of makers were
getting set to leave the U.S. market and sell only overseas, before the
government stepped in and stopped an out of control civil litigation
process.  This is fact beyond dispute.  If you think American industry
carelessness is to blame, you must explain why no foreign vaccine
manufacturer was willing to step into the US market, either.  Come on,
Jim, I'm sure we're all interested in your analysis of this.

  Anyway, that's what it took-- an entire industry about to disappear.
It took the same to save older private airplanes, since the courts
basically ruled that companies which made them were responsible for
their mechanical failures forever-- there was no provision in the law
for things just wearing out.  In order to save the private airplane
industry in the US, again the government had to step in and limit that
liability.  If it hadn't, you could not buy a new Cessna in the US,
because none would be sold.  Strange to tell, none of this has anything
to do with the competence of US physicians.

   For less obvious things than vaccines and aircraft, FYI, the
government does not step in, and the product you don't know about
simply ceases to exist.  If you need a lung lavage of fluorocarbon to
save your life if you have lung damage from a fire or shock, you're not
going to get it.  3M, which makes most of these chemicals, quite
deliberately got out of the medical market years ago, after the Dow
Corning Silicone suit.  So you're out of luck. You won't know why, but
that won't change a thing.  If your heart valve fails, you'll never
know that it might not have, if the suture 3M made for that purpose, in
a little tiny subdivision of the company, was still available.  But
it's not, since a giant company like 3M has deep pockets, and they
don't need the medical market liability grief.  Now, it's YOUR problem.

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: misc.health.alternative,misc.kids.pregnancy,sci.med
Subject: Re: Chiropractors threatening Wal-Mart?
Message-ID: <qtdy9.387$NI6.37354@newsread2.prod.itd.earthlink.net>
Date: Wed, 06 Nov 2002 18:47:50 GMT

stuart wrote in message ...
>
>"Wyle E. Coyote, M.D." <kidsdoc2000@hotmail.com> wrote in message
>news:C21FC6F47257DD31.FDD459E596DFFB93.77244504BC286924@lp.airnews.net...
>> True, especially for a malpractice attorny.
>
>Hate to tell you this, but, touch wood, 25 years in practice seeing an
>average of 35 patients a day, I have never been sued. Not once.



Me, either, but I've dealt mostly in geriatrics where expectations are
lower. The younger your patients, the greater your risk exposure in
medicine. It's worst in obstetrics.

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: Is it possible i have a scaphoid fracture?
Date: Sat, 02 Aug 2003 08:59:04 -0400
Message-ID: <bggcf8$3fb$1@reader1.panix.com>

Matt Beckwith wrote:
> "Pingu" <natasdavid@btinternet.com> wrote
>
>
>>I basically dont want to go to the doc for nothing and pay
>>loads of money for an x-ray if it definitely not needed.
>
>
> Is getting an answer to your question nothing?  And why would a doctor order
> an X-ray that wasn't needed?

Perhaps because missed scaphoid fractures are supposedly the leading
cause of lawsuits over missed fracture diagnosis?

I think the original poster needs to realize that there is no hope
of getting the sort of answer he is looking for. If people could
tell him over the Internet whether or not he had a wrist fracture,
x-ray machines would be an outmoded method of diagnosis. (Not that
plain x-rays are all that great for detecting scaphoid fractures.)

--
David Rind
drind@caregroup.harvard.edu

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: Is it possible i have a scaphoid fracture?
Date: Sat, 02 Aug 2003 15:08:06 -0400
Message-ID: <bgh235$95g$1@reader1.panix.com>

Matt Beckwith wrote:
> "David Rind" <drind@caregroup.harvard.edu> wrote
>
>
>>Matt Beckwith wrote:
>
>
>>...why would a doctor order
>>
>>>an X-ray that wasn't needed?
>
>
>>Perhaps because missed scaphoid fractures are supposedly the leading
>>cause of lawsuits over missed fracture diagnosis?
>
>
>>I think the original poster needs to realize that there is no hope
>>of getting the sort of answer he is looking for. If people could
>>tell him over the Internet whether or not he had a wrist fracture,
>>x-ray machines would be an outmoded method of diagnosis.
>
>
> First you say that a doctor is likely to order an unnecessary X-ray in fear
> of a lawsuit, then you say that the X-ray is necessary.  You can't have it
> both ways.

Sure I can. If he goes in to an emergency department with a wrist
injury he is extremely likely to have wrist radiographs performed,
particularly if he says something like "I'm worried I might have
a navicular fracture". He is probably less likely to have
an x-ray if he goes to a primary care doctor, but only slightly
less; primary care doctors worry about getting sued as well.

In both cases he is far more likely to get an x-ray than he is to
actually "need" one, if by need we mean any reasonable decision based
on the likelihood of fracture after a physical exam. This is one of
those situations where litigation has tended to drive the performance
of testing. The downside to the physician of failing to perform an
x-ray is so high that the physician will almost always recommend
an x-ray if there is any remote possibility of a navicular fracture.

So, while I don't think the original poster can possibly get the
answer he is looking for via the Net, I also think he is likely
to find that going to a doctor with wrist pain after an acute injury
will lead to x-rays even if the doctor's index of suspicion for
fracture is very low.

--
David Rind
drind@caregroup.harvard.edu

From: "Howard McCollister" <hmacXX@XXcharter.net>
Newsgroups: sci.med
Subject: Re: Litigation makes better doctors?  (was: Ordering Tests for Fear of 
	Getting Sued)
Date: 2 Aug 2003 22:24:06 -0500
Message-ID: <3f2c7fc3$0$66789$45beb828@newscene.com>

"Carey Gregory" <tiredofspam123@comcast.net> wrote in message
news:b7uoiv8rnh3fspntlrc74veurattl32v48@4ax.com...
> "Matt Beckwith" <matt@doctorbeckwith.com> wrote:
>
> >I think the fear of getting sued has made me a better doctor
> >over the years than I would have been had I practiced in a less litigious
> >country.
>
> Interesting comment....
>
> Ignoring the question of whether verdicts and awards are reasonable, how
> many doctors here would agree with that general statement?
>

Not I...

HMc

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: Litigation makes better doctors?  (was: Ordering Tests for Fear
Date: Sun, 03 Aug 2003 09:16:10 -0400
Message-ID: <bgj1v1$otk$1@reader1.panix.com>

Carey Gregory wrote:
> "Matt Beckwith" <matt@doctorbeckwith.com> wrote:
>
>
>>I think the fear of getting sued has made me a better doctor
>>over the years than I would have been had I practiced in a less litigious
>>country.
>
>
> Interesting comment....
>
> Ignoring the question of whether verdicts and awards are reasonable, how
> many doctors here would agree with that general statement?

It's an interesting question. One of the arguments for litigation is,
of course, that it keeps up the quality of medical care. People
have tried to look to see if this is true, but it's obviously hard
to show either way. Litigation is an extremely blunt instrument, and
most doctors feel that being sued is more akin to being struck by
lightening than to anything related to their own particular actions.
(And they are mostly correct in this; in Troy Brennan's study of
adverse events in NY State, about 10% of medically negligent harm
led to litigation and about 10% of malpractice lawsuits actually
seemed to be based on medically negligent harm.)

Dr. Beckwith's assertion that he practices better because of fear
of getting sued feels odd to me -- having a 20 year old die because
you didn't consider meningitis seems so much worse than getting sued
for the outcome that I have trouble believing litigation could generally
have a good impact in such a setting -- but I have to believe there
are situations in which he is correct that he chooses to be more careful
or learn more because of some additional fear to his livelihood.

Unfortunately, I would guess that there are also many situations in
which he practices worse because of this fear, where he orders too
many or more expensive tests than are really needed -- despite his
assertion I find it unlikely that fear of litigation only pushes him
in a good direction unless at baseline he is an extremely cavalier
physician who would otherwise rarely be pursuing an appropriate
evaluation. Most doctors need to constantly work at finding the
right balance between being too aggressive in evaluating problems
and not being aggressive enough, and litigation pushes that balance
in only one direction -- no one ever gets sued for ordering an
unnecessary MRI that finds an unexpected lung nodule that leads
to open lung biopsy that removes a benign lesion that should never
have been found in the first place.

--
David Rind
drind@caregroup.harvard.edu

From: David Rind <drind@caregroup.harvard.edu>
Newsgroups: sci.med
Subject: Re: Litigation makes better doctors?  (was: Ordering Tests for Fear
Date: Sun, 03 Aug 2003 13:08:54 -0400
Message-ID: <bgjfjb$sj0$1@reader1.panix.com>

Matt Beckwith wrote:
> "David Rind" <drind@caregroup.harvard.edu> wrote
>
>
>>Dr. Beckwith's assertion that he practices better because of fear
>>of getting sued feels odd to me -- having a 20 year old die because
>>you didn't consider meningitis seems so much worse than getting sued
>>for the outcome that I have trouble believing litigation could generally
>>have a good impact in such a setting -- but I have to believe there
>>are situations in which he is correct that he chooses to be more careful
>>or learn more because of some additional fear to his livelihood.
>>
>>Unfortunately, I would guess that there are also many situations in
>>which he practices worse because of this fear, where he orders too
>>many or more expensive tests than are really needed -- despite his
>>assertion I find it unlikely that fear of litigation only pushes him
>>in a good direction unless at baseline he is an extremely cavalier
>>physician who would otherwise rarely be pursuing an appropriate
>>evaluation.
>
>
> So, if I understand correctly, you're saying that, because I am motivated to
> do more for my patients over fear of getting sued, and because I've said
> that this is only in situations where I should have done more for my
> patients anyway, then I'm a physician who would not be a good physician if
> not for fear of getting sued.  Therefore I'm underneath it all not a good
> physician.
>
> Hm.  That sounds reasonable, actually.  Yes, I'd have to agree.  If not for
> fear of getting sued, I wouldn't be a good physician.

?

Assuming that last paragraph is meant to be sarcastic, I'm not
sure I get what Dr. Beckwith is saying. He said in another thread:

> I think the fear of getting sued has made me a better doctor
> over the years than I would have been had I practiced in a less litigious
> country.

I wasn't in any way trying to comment on whether Dr. Beckwith is a
good or a bad physician -- I have no idea. I was just responding
to the question asked by Carey Gregory about whether the notion
that fear of litigation could improve doctors seems reasonable.

I believe that on the margin it is possible that fear of litigation
might make someone more careful or learn more (which I assumed was
why Dr. Beckwith felt that the fear of getting sued had made him
a better doctor), but I also believe that on the margin fear of
litigation leads to unnecessary testing and potentially harmful
cascades of false positive results and harmful workups. So other
than with a doctor who is way at one side of the Bell curve on
taking patient problems seriously, I have to think that fear of
litigation would not have only positive effects but would also
cause harm -- this did not mean that I think Dr. Beckwith is
such an outlier; I know nothing about him.

I've almost never heard a doctor make the assertion that Dr. Beckwith
made about fear of litigation, and was trying to take it seriously.
I'm not sure why he reacted as if I'd said he was a bad doctor, but
my sense is that he misunderstood what I was writing.

--
David Rind
drind@caregroup.harvard.edu

From: "Steve Harris" <sbharris@ix.RETICULATEDOBJECTcom.com>
Newsgroups: sci.med
Subject: Re: Litigation makes better doctors?  (was: Ordering Tests for Fear of 
	Getting Sued)
Date: Sun, 3 Aug 2003 20:10:45 -0700
Message-ID: <bgkirl$emf$1@slb9.atl.mindspring.net>

"David Rind" <drind@caregroup.harvard.edu> wrote in message
news:bgj1v1$otk$1@reader1.panix.com...
> Most doctors need to constantly work at finding the right balance
> between being too aggressive in evaluating problems and not being
> aggressive enough, and litigation pushes that balance in only one
> direction -- no one ever gets sued for ordering an unnecessary MRI that
> finds an unexpected lung nodule that leads to open lung biopsy that
> removes a benign lesion that should never have been found in the first
> place.


You mean unnecessary helical CT?  Unless MRI's are a lot
faster when you are, than where I am.

Some guy on Health and Age claimed his father had an
incidental lung nodule discovered after a "MRI" for a pelvic
fracture, but that would have been a fast CT also. He's
confused and the doctor didn't correct him.

In any case, your point is made. There's a lot of wasted
testing out there, and top of my list is MRI for back pain
in a patient you'd never operate on anyway. So what's the
point?  I keep asking, and nobody seems to want to answer
me.

Perhaps there are orthopods who will do microdiscectomies on
everyone with back pain and a bulging disk on MRI, but who
the devil employs such people?  Medicare? California
Medicaid?  Inquiring minds want to know. Nobody would do
this out of pocket unless they'd been in severe pain for
months with inadequate drug treatment and a lying orthopod
who suggests it might be that way for the rest of their
natural lives....

In any case, I've seen many MRIs ordered by orthopods and
paid for my HMOs and insurance companies that I know would
never authorize any kind of surgery for the clinical
syndrome I'm seeing. It's enough to make you suspect some
giant conspiracy of radiologists. Or radiology kickback to
ortho? Whatever it is, it's weirder than a snake's
suspenders. "I just wanna see what's in there" is not a
great excuse when your intellectual curiosity is costing
somebody a thousand bucks.

SBH