Price is high for preventing medical lawsuits

Dr. Alexander Strasser – Guest essayist
http://www.democratandchronicle.com

Trial lawyers have had a major impact on medical care. The implied threat of a malpractice suit whenever an outcome is not entirely satisfactory to the patient and family has forced physicians to practice defensive medicine. This is especially true in radiology.

It is well known that a chest film given to three board-certified radiologists may result in three different interpretations. So, out of fear of a malpractice suit, radiologists have become vague in their reports. This explains why referring physicians often receive a report stating, “Clinical correlation is indicated; consider a CT scan for more information.” Once a physician receives such a report, he or she has no choice but to order a CT scan. Many of these repeat tests are not medically indicated, but legally necessary.

Similar concerns exist in interpreting barium enemas, ultrasound examinations, MRIs and all forms of diagnostic imaging. CT scans and MRIs identify shadows, many of which are not relevant to the particular case. When medically indicated, additional tests should be done. But who decides what is medically indicated? Is it the insurance company, the malpractice attorney or the attending physician?

The potential pitfalls of CT scans and MRIs only scratch the surface. The same concern exists for all diagnostic studies. When is an upper endoscopy or colonoscopy necessary? How often should they be repeated? No clear-cut medical answer exists, as physicians do not have a crystal ball.

To a physician, the bottom line is the patient’s welfare. Stated another way, do what is necessary but cause no harm. This sounds simple, but in clinical practice, it does not work. Experienced physicians will admit that many times they just do not know what tests are appropriate and will bend over backwards to guard the patient’s interest.

Another case in point is multiple drug regimens. Physicians do not always know when drugs will interact. The pharmacist’s computer can pull up a list of potential interactions, but he or she is not always aware of the dangers of adding a new medication to a patient on multiple medications.

How often should a PSA test be repeated in an elderly male? When is a prostate biopsy necessary? Clinical guidelines do not solve these dilemmas either.

The solution is malpractice tort reform, but this is most unlikely to be passed by the New York state Legislature given the influence of trial lawyers.

Physicians have responded by leaving the state or not settling here in the first place.

After all is said and done, is there anything positive about the influence of trial lawyers? One can speculate that the fear of being sued makes the very few doctors who perform sub-par medicine more careful; but looking over a physician’s shoulder can also be very detrimental.

In the end, the price for this so-called deterrent is too high and one that society cannot afford.

Strasser is an internist in private practice in Penfield.

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