As a primary care internist with a practice in North Atlanta, I recently ordered a CT scan for a healthy 41-year-old male patient complaining of abdominal cramping. He was not experiencing fever, chills, diarrhea or vomiting, but he was losing weight and feeling generally fatigued.
Many would think a $2,000 CT scan would be an unnecessary test for a patient who likely had a “stomach bug.” But this time it showed multiple areas of infection and diseased intestines due to a previously ruptured colon. He was sent for emergency surgery, which saved his life.
I did not order this test out of fear of a lawsuit, but rather due to clinical intuition arising out of a strong physician-patient relationship.
That’s why I applaud the creation of “Choosing Wisely,” a partnership between Consumer Reports and the American Board of Internal Medicine Foundation recognizing the importance of physician-patient conversations to improve care and eliminate profit-driven tests. Unfortunately, some special interest groups are exploiting the collaboration by arguing that doctors run unnecessary tests to avoid being sued. Their proposed solutions are to grant health care providers immunity from being held accountable and radically reforming our medical justice system.
“Defensive medicine” provides a convenient distraction from the real issues that plague our health care system. The vast majority of research has uncovered little evidence that it is prevalent. The federal Government Accountability Office has questioned the occurrence of defensive medicine, saying costs have not been reliably measured. Existing surveys often rely on narrow surveys of doctors with biased wording and low response rates to bolster their claims.
In my experience, the drivers of medical treatment decisions are more complex. Doctors who put patients through uncalled-for tests are not practicing defensive medicine — they are practicing bad medicine. Most often, doctors conduct the tests and procedures they believe necessary based on their judgment and the needs of individual patients — not due to liability concerns.
As a physician, it concerns me to see interest groups aligned with our profession focus more on protecting negligent doctors than on reducing preventable medical errors. Increasing patient safety will lead to a large reduction in health care costs. The Institute of Medicine estimates there are 98,000 deaths annually due to preventable medical errors in hospitals. These errors increase health care costs by $29 billion per year, more than five times the savings that would supposedly come from limiting patients’ rights. We need to reduce health care costs for Georgians and can do so by reducing preventable medical errors. We can’t afford to allow special interests to distract our policymakers from this important mission.
Dr. Kelly B. Thrasher of Atlanta specializes in internal medicine.
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