I agree and disagree with Kenneth J. Bush’s July 13 letter, “Healthcare funds.” He wrote in response to a prior letter by Ira Jacobson, which listed “defensive medicine” as part of the rising cost of healthcare in America, specifically in Miami. Defensive medicine involves not only malpractice issues, but also diagnosis.
Here is where I disagree with Bush: To deny that the threat of malpractice for omitting some lab or imaging tests that might have helped the doctor make the correct diagnosis ignores reality.
Clinicians must think first of the welfare of their patients, but every diagnostician in America must also consider the constant threat of missing the correct diagnosis because of the failure to order the right test. Tests ordered might not be to rule out the most probable cause of an ailment, but to rule out even the most remote possibility thereof.
All those tests are driven first by the concern of the physician for the patient’s welfare. Secondarily, they are driven by the threat of malpractice suits if some test is omitted. That is defensive medicine. The costs of these tests are part of and add to the healthcare costs as Jacobson opined. Physicians must and do think first of making the correct diagnosis for the welfare of their patients, but they must consider the possibility of being sued, as well. That is the likely reason so many so-called “unnecessary tests” are ordered.
Are those tests truly unnecessary? Hindsight is 20/20, and when those tests come back normal, the patient and the physician breathe a collective sigh of relief. If tests that might have helped make the correct diagnosis are omitted, a suit is sure to follow. That’s why the practice of defensive medicine is prevalent in America.
I do agree with Bush that if ordered lab tests and imaging studies do not benefit the patient, then it is fraud. No ethical physician would ever do that.
Robert E. Pickard, M.D., Miami