Umm… yeah, we do.
So, remember earlier this year when I found out I got sued? It was because we didn’t do a bunch of labs that, though completely medically unnecessary and against the standard of care, the family thought would have “saved” their loved one from death.
There are certain things that have become standard out there, and if you don’t order a certain test and you mess up, you WILL get sued. This happens a lot more in the hospital than in the outpatient setting. As a general rule, the sicker the patient is, the more unnecessary tests they get.
Patient says they have the worse headache of their life? Doesn’t matter that they come to the ER for that same complaint once a week for Dilaudid. They’re getting a CT scan to rule out a bleed.
Patient has burning chest/epigastric pain that is obviously coming from their severe chronic esophagitis? Better get a stress test or a cath just to be sure it’s not their heart.
We do this stuff ALL the time. One of the things I love about doing medicine overseas is that this burden to CYA is lifted and you can practice medicine in a logical, common sense, prudent way while still treating the patient completely appropriately for their condition.
But as long as we judge the quality of a doctor’s care by patient satisfaction scores and we allow people to sue for ridiculous things and ask for ungodly sums of money, doctors will continue to practice defensive medicine.
There is a point where it gets out of hand though. In my opinion, if you’re draining the system or potentially causing harm to the patient with all your CYA tests, you’ve gone too far. And I think a lot of doctors order tests without talking to the patient first because they assume all patients are litigious, but if you and the patient can come to an agreement not to do an
expensive unnecessary workup, then it’s fine.