One In Five Million

You have to wonder if Mikey would ever happen to mention, when he talks about the cost of medicine, something about this:

I was appalled to learn of a colleague’s fate at the hands of a Mahoning County (Ohio) jury in a recent malpractice case. The patient presented with what any prudent physician would deem to be muscular back pain and went on to die of an aortic dissection. Given the patient’s age and sex, the likelihood of such an occurrence would be about two in 10 million.

The likelihood in the presence of back pain would be higher, but given the particulars of the case would still be vanishingly small. Making the diagnosis in a case like this would require a policy of obtaining a CT scan on virtually every case of back pain.

Why not obtain a CT scan on every patient with back pain or, for that matter, perform every test known to medical science on every patient who is ill? After all, peoples’ lives are at stake.

There are two reasons. First, nearly every test in medicine is inaccurate. A test that is positive often leads to further testing which, if the test result is in error, is unnecessary. Such testing is sometimes invasive and therefore potentially dangerous, and if the patient is hospitalized unnecessarily there is the additional risk of life-threatening infection. Because of this, the search for extremely unlikely diagnoses would kill more patients than would missing those diagnoses. Researchers at Dartmouth University have shown that more care is often worse care.

The second reason is cost. Embracing this policy would necessitate closing the Pentagon and abandoning public education. As it is, some of my younger colleagues, paralyzed by the fear of being sued, regularly spend $2,000 to diagnose a cold.

Malpractice is defined as a bad outcome resulting from negligence; negligence is defined as other than what a prudent physician would do in similar circumstances. That my colleague acted prudently is beyond dispute. The patient was a victim of fate, not negligence. My colleague was a victim of a process wherein a class of professionals with the morals of a drug dealer hires medical prostitutes to mislead juries in order to win the malpractice lottery. Nationwide, the money being diverted from patient care to service this process is $192 billion per year, approximately 10 percent of the entire cost of health care, enough to pay for all the costs incurred by America’s uninsured more than twice over, and far more than the annual cost of the wars in Iraq and Afghanistan.

I’ve probably said this before, but there is a perception in America that doctors note symptoms, look them up in a great big book and come out with a perfect diagnosis.  It ain’t so.  Medicine is as much art as science, as much instinct as knowledge.  Our bodies are not very good at indicating what’s wrong with them and most physicians have to to act on incomplete knowledge.  When they guess wrong—even when the right guess was a two in ten million shot—they get sued.  And we all pay.  Not only with malpractice premiums but with the cost of unnecessary tests.

But forgot that.  Our expensive healthcare system is entirely the result of evil insurance companies, evil drug companies and evil providers.  Don’t think.  Just feel. That’s it.  $8 for adults.  $4 for children.  Be sure to buy the DVD.