• Extra care to avoid lawsuits is bad! Except when it’s mammograms?

    Arguments Discussions about health care reform are unavoidable for me over the holidays.  But the most frustrating one for me concerned the ability of friends and family to somehow merge their anger about the lack of malpractice reform and the USPSTF’s trying to recommend that early screening mammograms might be unnecessary.

    Understand that most people who support malpractice reform do so because they thing that it’s adding significantly to health care costs.  It’s doing so because of the practice of defensive medicine (emphasis not mine):

    Both of my parents are physicians in Massachusetts, and, while they may be biased in their opinions about the merits of malpractice, they emphasize that it has caused them more and more to practice defensive medicine.

    Simply put, defensive medicine is the use of medical practices designed to prevent malpractice.  A 25 year-old kid may come to a physician complaining of chest pain.

    The likelihood that they have a life-threatening condition is as close to zero as can be doctors will order an MRI just so that they cannot be sued later on for not following procedure.  What that means is that insurance pays $1,000 for an unnecessary procedure, which could’ve been spent on something worthwhile.  Physicians study and work for 8 years post-college in order to ply their trade, and in a lot of situations, are equipped to make decisions without the need for costly tests.  Defensive medicine leads to hundreds of billions of dollars in wasted medical spending – money that could spent elsewhere.  Tort reform should be a major consideration in reforming the healthcare system.

    Now understand, not all “defensive medicine” is bad.  Sometimes, doctors pick up something that seemingly validates the practice.  It’s just “waste” in that people believe that the expected cost of the extra tests outweighs the benefits; therefore, it has to go.

    This is pretty much the same argument now being used by the USPSTF.  They are saying that screening mammograms for 40 year old women may pick up things once in a while.  But the costs (in terms of potential harms) may actually be greater than the benefits.  They don’t mention it, but I will – the financial costs may not be worth it either.

    This week I can’t count the number of times people who absolutely think that malpractice reform will be the savior of health care costs – because it will allow doctors to stop ordering such tests – were absolutely sure that the actual practice of stopping ordering these tests is rationing of the worse sort.

    Look, I’m not saying that screening mammograms for women in their 40’s are awesome or horrible.  It’s obvious that the data are murky at best.  But what’s the point of malpractice reform if we can’t even talk about reducing the ordering of tests for things for which the benefit is ambiguous at best?  What tests did they think we were going to save money on?

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