From: geb@dsl.pitt.edu (gordon e. banks)
Newsgroups: sci.med
Subject: Re: Rising Medical Costs. Was: Mercury in fillings?
Date: 8 Sep 92 22:00:39 GMT
Organization: Decision Systems Laboratory, Univ. of Pittsburgh, PA.

In article <BtzHwq.31u@wpg.com> russ@wpg.com (Russell Lawrence) writes:
>From article <16312@pitt.UUCP>, by km@speedy.cs.pitt.edu (Ken Mitchum):
>km> The fact is, there are a lot of unnecesary things being done
>km> in medicine today - that is precisely the fact behind the drive
>km> to "managed care" and physician accountability: if unnecessary
>km> things were not being done, then the people behind these
>km> ideas would not have any basis on which to limit costs.
>
>I agree that there are a lot of unnecessary procedures.  
>
>Consider, for example, an HHS study conducted several years ago 
>which found that 12% of all doctors who treat medicare patients 
>were involved in joint-venture kickback schemes whereby they made 
>extra bucks by referring their patients to outside labs which they 
>themselves partly owned.  According to HHS, patients who were 
>treated by such doctors received 45% more tests than other 
>patients.  Yikes!  
>

Interesting how when you are trapped you always deflect by
changing the subject.  And I'm sure you recall the many
times I have denounced the practice of doctors referring
to their own labs as conflict of interest.  And how both
Ken and I have adamantly opposed the AMA, yet, this is
your answer to Ken.

>km> There are many reasons for unnecessary things being done, and
>km> I can tell you that ONE of these is the malpractice problem.
>km> I can only speak for myself, but I know that many of the tests
>km> I order every day are for the chart only: I know what the
>km> results are going to be before I order the test, and the chances
>km> of the test influencing what happens to the patient are very
>km> low.
>
>It must be nice to know what the results of a test will be before
>you order the test.  Are you ever wrong? :-)
>
Everyone is wrong at one time or another.  But does this mean
we have to order every test that might have a finite probability
of showing up something on every patient?  And if it is normal
today, are we sure it will be normal next week?  Lawyers will
argue this in malpractice cases, but do you realize what
this is doing to health care costs or even worse, what it would
do if it was carried to your absurd limit of ordering every time
you have the least uncertainty?

>Let's not forget the root problem of malpractice litigation...
>namely fraudulent or substandard medical care.
>
The root problem isn't that.  It is our legal system.
Injury due to malpractice occurs in every society and
system.  In Europe and Canada, they have a much more
cost effective way of handling it than trial by jury of
laymen.  And I'll bet that studies of their way would show
that more of the injured get helped at a far less cost.
Here, most of the injured get relatively little while
some get astronomical settlements.  But the lawyers always
win.

-- 
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Gordon Banks  N3JXP      | "Skepticism is the chastity of the intellect, and
geb@cadre.dsl.pitt.edu   |  it is shameful to surrender it too soon." 
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Newsgroups: sci.med