Paul S., a doctor from New Mexico, writes:
Another issue that is important is the medicolegal cloud that hangs over everything we do. Your example of the cost of a Medicare patient differing between Florida and Colorado is a simplistic view of the issues. Why do MDs order more tests? I get no extra reimbursement for tests I order in the hospital -- zero. The easiest thing for me is to "order the aspirin" and send the patient home. That way I get to go home early and see my kids.
The reason is because of the odds game. Medicine is not exact. We make diagnosis based on odds. Your patient example may have a 1-2 percent risk that this chest pain is a heart attack. 98 times I make the right decision to send him home, however, if I am wrong and the patient has a heart attack, I'm at fault. In states that have an onerous tort system (Florida is one of them), MDs treat patients not to miss the 1-2 percent heart attack as opposed to playing the odds this is simple non cardiac chest pain.
If you have ever been sued, it is an extremely distasteful experience. The opposing lawyers job is to prove you incompetent, saying the odds were against this being a heart attack does nothing to win over a jury or family members of a loved one that passed away. This causes MDs to practice defensive medicine -- I am going to treat this patient as if this is a heart attack until proven otherwise. That means I will order the MRIs, CAT scans etc. You may catch that heart attack 1-2 percent of the time but the other 98 percent is wasted resources.
I guarantee that states that have a more robust tort system have higher medical charges. Bottom line, if you want MDs to be more economical, something medicine does not teach ("Do everything you can for your patient"), you are going to have to fix the medicolegal system. Even if I get sued on a case where I know I did nothing wrong and it's unlikely to go to court, my malpractice premiums go up, and I have to take time away from my practice and family to deal with lawyers. This complaint is now permanently on my record. Fixing health care requires tort reform!!!!! Something President Obama has stated publicly he is unwilling to do! So much for change.