By Mike Twohy in the New Yorker.


    • Not to hijack a humorous post, but I do struggle with the contradiction between my personal observations of defensive evidence and the ineffectiveness of tort reform. The bottom line is I do think doctors order more tests than are medically necessary in order to “cover their ass,” but tort reform doesn’t really seem to change that behavior all that much.

      Perhaps caps on non-economic damages are simply not a big enough difference to change behavior. Perhaps defensive medicine is so culturally ingrained that it will take decades and a new generation of physicians to adjust to different malpractice climates. Perhaps “covering my ass” doesn’t just mean avoiding a malpractice suit, but also a general bias toward more aggressive treatment than objective analysis would suggest. And perhaps my anecdotal observations are off-base.

    • The thing about tort reform, though, is that it doesn’t address the problem, which is the gross amount of medical malpractice and bad practice in the US. There are many times more hospital-acquired infections in US hospitals* than there would be if doctors washed their hands more often and nurses were more careful inserting central lines. That’s a lot of people dying unnecessarily, my father included (“He’s doing fine. We’ve got the pneumonia and urinary tract infections pretty much under control”, infections he didn’t have when he fainted at home (a problem itself caused by inappropriate medication with a known blood-pressure-lowering side effect)). The ACA, with its insistance that hospitals take financial responsibility for medical problems they cause, is a great start here.

      The idea that cover-ones-arse testing and malpractice law have anything to do with the problems in the US medical care systems is seriously ridiculous.

      *: A quick google turned up “A recent study by the Journal of the American Medical Association found that medical malpractice led to 225,000 wrongful deaths from preventable medical errors annually, making medical malpractice the third leading cause of death in the United States, following only heart disease and cancer.”