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PeterBarry CarolAnirbanSidney Schwab, MDTom Leith Recent comment authors
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Peter
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Peter

I was referring to in hospital billing/defensive med. Docs who have no financial gain at ordering tests would more likely be motivated by good practise, defensive or not, but maybe they’re just poor diagnostians. If there’s no downside for the doc to order additional tests human nature would say do it. But in a for profit hospital setting when departments are held to be accountable for revenue would there be a tendancy to add a few more tests or procedures for a patient? When a hospital “invests” in an MRI isn’t there pressure to use it? Human nature would say… Read more »

G. Hinson, MD
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G. Hinson, MD

Peter, don’t be ridiculous. If I were to order something “defensively,” it is likely going to be expensive blood tests or an MRI or CT scan. Only a minority of physician practices, and very few small groups, have labs in their offices. And even fewer physicians are able to order and bill for tests like MRIs. Tests that are done in a hospital, only benefit the hospital, not the physician doing the ordering. See, this is one of the things that drives me crazy regarding the costs of medical care. Someone comes into my office with belly pain, and I… Read more »

Peter
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Peter

How much of this so called “defensive” medicine is just a need to increase billings?

G. Hinson, MD
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G. Hinson, MD

Here, here Barry. I strongly agree with the idea of specialized health courts. I especially like the thoughts of this organization–http://cgood.org/healthcare.html.

Barry Carol
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Barry Carol

Dr. Hinson, that was a very interesting and informative post on defensive medicine from a doctor’s perspective. With respect to the culture of litigation, I think it would be helpful if malpractice suits were taken out of the hands of juries, who are generally not qualfied to judge competing scientific claims and are easily swayed by emotion and sympathy for someone who had a bad medical outcome but not necessarily due to malpractice. Instead, there should be specialized health courts with judges who have built a body of knowledge in the medical field and can specialize in hearing medical litigation… Read more »

Tom Leith
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Tom Leith

> Fixing healthcare is about more than cutting pay for > docs, nurses, and hospitals, which is pretty much > the only focus to date… The focus was deeper in the 1980’s but patients hated it even more than doctors did, and now it is pretty much illegal to have a deeper focus. Which some commentators here will tell you is just as well. > Mediocrity is believing that healthcare is good enough I like this very much. Dr. David Pryor of Ascension just gave a talk a couple of weeks ago to a bunch of evil managers, and asks… Read more »

G. Hinson, MD
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G. Hinson, MD

Barry, defensive medicine is definitely part of the picture. Hard to quantify how big a piece of the pie it is. And we have now trained a whole generation of doctors to practice defensively. It is amazing how much “CYA” is a part of the language of residency training. As such, finding a way to fix the culture of litigation we have right now will only slowly improve things. Most doctors, if you ask them during the work day how many extraneous tests were ordered will tell you none. The invisible lawyer in the exam room makes us order the… Read more »

RW
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RW

Mediocrity is believing that healthcare is good enough; that all you have to do every day is make sure the doors are open and that no one gets upset; that more is better; that “my patients are sicker”; that continuing education is the lecture between the slopes and the hot tub; that access is just about insurance; that all doctors are about the same; that we can design clinical services without a physician leader; that a solo practioner can provide just as good of medicine as a multi-specialty group; that calling something an “Institute” or “Center” makes it special; that… Read more »

Barry Carol
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Barry Carol

I would like to focus on the issue of defensive medicine. Suppose I go to a doctor (either primary care or specialist) that I have been referred to by another doctor whose judgment I respect. I say, doc, you are very well respected in your field and my referring doctor says you are among the very best. I respect your knowledge, your credentials and I trust your judgment. However, I am also concerned about costs. Even though insurance is paying most of the bill, my policy has a lifetime benefit cap. So, what I really want you to do is… Read more »

Anirban
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Anirban

I just found the blog a bit later .Wish could participate early on. No one can afford to ignore Mayo, if I meant that and not everyone has the potential to become like mayo that is my point. Even with in Mayo not every physician is equal, illustrating a kind of Bell Curve of its own. Respecting all the qualities, all far right hand of the curve, we know about Mayo that you enumerate, could well serve a model for other institutions. Too much activity what you see in health care as a ‘pursuit of mediocrity’, wouldn’t be there if… Read more »

RW
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RW

I realize this thread is getting old, but I just can’t let this go by. While I am a believer in the bell curve, to say that you can’t change or move the curve within any particular setting or group is, well just not correct. An “not withstanding Mayo…” – well THAT IS THE WHOLE POINT – you can’t ignore them. The reason they are better than average is because they create an environment where excellence can be pursued. They move the curve to the right within their setting. The way they are organized supports quality, continous improvement and the… Read more »

Anirban
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Anirban

Any bell curve suggests that the most excellent and most lousy physicians will lie at the extreme ends and the average will populate the middle .Not withstanding some Mayo or Cleaveland clinic the whole mass of physicans will be just average, whatever you try. they can’t be excellent because the excellent cant improver his/her perfection. This applies to any sphere of life and so its here. In a HMO system the whole idea of administrators cutting the cost is a hoax.They simply can’t if they do will be at a terible price what they cant’t measure in Dollers and Cents.… Read more »

Sidney Schwab, MD
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Sidney Schwab, MD

If I may be so bold, I’d like to mention my book, just now available, about internship and residency at UCSF in the 1970s. I think it gives a good picture of what one goes through to become a surgeon; and it contains some speculation about then vs now in terms of work hours, etc. Even though it’s meant to entertain and enlighten, it seems relevant to the discussion in this thread. The book is called “Cutting Remarks; insights and recollections of a surgeon” and is available at amazon, among other places. Comparing surgery and strawberries, while a nice talking… Read more »

RW
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RW

“Administrators are responsible for much of what is wrong with healthcare” – that is the title of Dr. Tuteur’s latest posting over at her blog. Wow. How can you act so defensive on the one hand here at an imagined slight, and then go make such broad sweeping generalizations about an even broader group. I think an “administrator” must have kicked your dog when you were a child or something. You can’t have it both ways – where doctors are responsible for everything good in healthcare and administrators are responsible for all that is bad. If you really want to… Read more »

Amy Tuteur
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Physicians and administrators can argue back and forth, but the most meaningful parameters are those that involve the patients. I would submit that over the last 20 years of healthcare “management”, the patient experience has deteriorated in every way: 1. The cost of healthcare has not gone down as promised, it has gone up, both in terms of insurance costs and co-pays. 2. The administrative hassle to patients has risen dramatically as insurance companies arbitrarily refuse to cover various items. Spent any time on the phone with an insurance company lately? It’s a nightmare. 3. The doctor-patient relationship has been… Read more »