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So many lawyers, so little time...

"The prospect of hanging focuses the mind wonderfully"--Samuel Johnson

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Location: Louisville, KY, United States

Gastroenterologist, cyclist, cellist, Christian, husband, father, grandfather.

Friday, February 18, 2005

Standard of care

Back in the early 90's if we found a colon polyp we would do a follow-up colonoscopy in one year, then repeat the exam in three years. A few years ago the guidelines were changed: after the initial colonoscopy we now wait five years before updating the examination, with occasional exception.

A recent study in the Annals of Internal Medicine asserted that we do too many colonoscopies. Physicians just can't let go of the old guidelines, it seems, and the result is unnecesary scopes. This study received a lot of flak on scientific grounds, and no doubt will remain a source of controversy for quite some time.

My response is not so scientific: studies like this really chap my hide.

If a patient requests a colonoscopy and you don't perform one because it doesn't adhere to existing guidelines, God help you if the patient ends up having colon cancer. If the patient requests ANY test and you don't order it because in your judgment it isn't necessary, God help you if the patient ends up with a serious disease that could have been diagnosed with the "unnecessary" test.

Lawyers think this is a good thing. "When it comes to my health," my lawyer intoned, "I want you guys to practice defensive medicine. I don't want you to miss anything at all, even if it's rare and requires lots of expensive tests to diagnose."

Whether we like it or even acknowledge it, the "leave no stone unturned and damn the expense" has become the standard of care for American medicine.

Which is why I got sued in 2000.

To be continued.


Anonymous Urska said...

What exactly is wrong with the "leave no stone unturned and damn the expense"? You wouldn't want such approach on you if you were a patient? You know what...there should be a certificate issued for this and every doctor who qualified for such certificate would have a sticker on his doors that read "We turn every stone no matter what the expenses" and with that sticker would come the privilege to not be sued ever :))

5:11 AM  
Blogger JusPasenThru said...

That's a great question that defies a short answer, but I'll try. 1. Subjecting the patient to numerous tests often exposes them to risk. For example, get enough Xray tests and your risk of cancer goes up. 2. Assuming that every symptom can be diagnosed with some medical test ignores the spiritual and psychosocial aspects of our lives. 3. The huge amount of money that we spend on medical testing could be better used in public education and preventive medicine, in my opinion. I hope that helps some.

9:53 AM  
Anonymous D.C. Chang said...

Urska, sometimes the "leave no stone unturned" approach to medicine causes problems. A prime example is the PSA test looking for prostate cancer. The evidence for decreasing mortality with this screening test is weak. To try to make a complicated story short, the PSA test often ends up finding prostate cancer in many people that would die of other causes such as heart disease, stroke, and so on. Such a person might die from congestive heart failue rather than untreated prostae cancer, which is often slow growing. The negative aspect of doing this test is excessive anxiety and unnecessary biopsies and cost.

7:36 PM  
Blogger Ed said...

Re: Urska's comment:

I wouldn't have a problem with a "leave no stone unturned and damn the expense" type of comment if it were the people making the comment paying out of their own pocket. If you want to pay for it yourself, then "damn the expense" indeed.

However, when there's cost-shifting (insurance, worker's comp, third party liability, etc.), that's too easy a mantra, too cheap a way of thinking.

Folks who argue this mantra would not think that way if they had to deplete their own accounts to pay for the tests. Health care isn't a right, it's a commodity, and it has a price (and a benefit).

So, if Urska and everyone else who thinks that would just pay the entire cost out of their own pocket, and not burden the rest of us (taxpayers, customers of insurance carriers, consumers), that's fine.
Involve us, and cost-benefit analysis is worthy of comment.

4:54 PM  
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12:40 AM  
Anonymous Anonymous said...

A polyp> is a growth of tissue projecting from a mucous membrane. If it is attached to the surface by a narrow elongated stalk, it is said to be pedunculated. Polyps in the colon are typically are harmless; but, sometimes these polyps have the potential to become cancerous over time.

more info about polyps

2:49 AM  

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