A recent report highlights the colossal waste imposed by our health care system, and the price tag is a whopping 700 billion per year. According to the report, 60% of this waste is attributable to outright fraud and repeated medical mistakes.
The remaining 40% is attributable to unnecessary tests, commonly known as "defensive medicine," i.e physician ordered tests to avoid malpractice exposure. The AMA and certain politicians are famous for decrying "defensive medicine" as a reason for medical liability "reform."
But here's the problem: how do you OBJECTIVELY define what exactly is defensive medicine? A few examples illustrate how that term can be twisted and "spun" for political mileage. A few years back, I developed chest arm pain and numbness while driving. I visited my family doctor, whom I respect greatly. When I explained my symptoms, he said: "You exercise and are not overweight, and I am convinced that your symptoms are not heart related. However, to make absolutely sure, I will order a stress test just to be safe."
Sure enough, the test was negative. I can assure you that my doctor ordered this test for one reason: he was concerned for my well being, and wanted to rule out the rare possibility that I had a heart problem.
Yet, ordering my stress test could have easily been labelled "defensive medicine" by those inclined to label it as such in order to proclaim that malpractice avoidance was the sole reason for ordering the test. That's where the defensive medicine label becomes mushy; many tests are ordered to rule out the low possibility of a potentially lethal problem.
Likewise, if you go to the ER with the worst excruciating headache of your life, and have no history of massive headaches, chances are that you probably don't have a brain bleed or aneurysm. Yet, if there's a 5% chance you're experiencing a brain bleed, there's a good chance you might drop dead if you leave the ER. So if the ER doc orders a CT Scan to rule out a brain bleed, is is being ordered it SOLELY to cover the doctor's butt against a malpractice claim, or is it being ordered as a cautious and prudent measure to rule out the possibility of a remote but lethal condition?
Ask anyone if they would want a CT Scan under those circumstances and 100% of all people would want it. Yet, a physician might claim that this was purely "defensive medicine."
Moral of the story? It's easy and convenient to label tests as "defensive medicine," even if they can be medically justified. But one doctor's defensive medicine is sometimes prudent medicine in the eyes of the patient.
All this aside, here's the absolute BEST question to ponder on this issue: would the doctor order the CT Scan if it were his parent, spouse, or child, or would he or she just send them home? Hmmm....