david rind

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

steve harris

Most doctors need to constantly work at finding the


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

keith f. lynch

Why do MRIs and CAT scans cost so much money? Electricity and
computer power are cheap. Strong magnets may be expensive, but
they're amortized over many patients.

If it's true that MRIs can localize brain activity, then possibly
someday we'll replace keyboards and mice with MRI helmets, so people
can *think* text and graphics onto the screen. Any reason MRI
machines couldn't be built into helmets, or why everyone wouldn't
be able to afford one if they were? Thanks.
--
Keith F. Lynch - kfl@keithlynch.net - http://keithlynch.net/
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