Utah Med Law

If you had any doubt about health care reform being about money this article should show you that all of the interested parties, including health insurers, doctors and facilities have their (and not the public) interest at heart.

There was a recent article in the Atlanta Business Chronicle titled "Survey: U.S. docs want tort reform."  The article quotes a survey published by Jackson Healthcare - an Atlanta-based company that provides clinician staffing, anesthesia management and health care information technology solutions.  The article claims that 85% of the doctors surveyed said that the threat of medical malpractice litigation is the primary hindrance to practicing medicine as they see fit.  Furthermore, the article states “We found that regardless of a physician’s political affiliation, the respondents attributed the practice of defensive medicine to excessive waste in the health care system,” quoting Rick Jackson, chairman and CEO of Jackson Healthcare.

The problem here of course is that practice as they "see fit" is killing people.  As a medical malpractice attorney and an occasional consumer of health care, I am happy that physicians practice with one eye to medical malpractice.  The threat of medical malpractice makes them practice medicine in a way that it should be practiced.  The threat of medical malpractice makes doctors spend time with the patient and makes them order appropriate tests to rule out life-threatening illnesses.  Medical malpractice makes physicians practice medicine according to an accepted standard of care.  If they deviate from the accepted standard of care they commit medical malpractice. 

Physicians often claim that the threat of medical malpractice makes them order tests that are not really needed but they order them anyway to make sure they can avoid medical malpractice claims. The doctors claim that unnecessary tests add to the cost of health care unnecessarily - they have named these unnecessary tests "defensive medicine."  Even though that sentiment may be widely held by doctors there is no objective evidence that shows doctors are practicing defensive medicine.

The problem with defensive medicine is not that the tests are ordered but how health insurers, doctors and hospitals are paid.  Everybody gets their cut from the ordered tests.  Let's say that your doctor orders an MRI to check out your complaints of abdominal pain.  That MRI is first ordered by your physician and he or she orders you to return in a week to review the outcome of the MRI.  Caching!  That is another visit to your doctor and another fee for him or her.  You of course go to the hospital and get the MRI.  Caching!  The hospital bills the insurance company a fee for the MRI.  Caching!  The health insurer pays the bill but at a reduced negotiated rate.  Caching!  The health insurer makes money on the negotiated difference between that billed and that paid to the hospital.  You follow-up with your doctor and he or she refers you to a surgeon because your primary care physician is not an expert at abdominal imaging or surgery. Caching!  The specialist gets a fee when you visit them for evaluation.  Caching!  It goes on and on....

Maybe it is time that physicians and health care facilities get out of the habit of ordering tests so they can earn more money and practice medicine that meets the accepted standard of care!