I’ve largely jumped off the soapbox because I realized something: no one is really listening. Most readers of this blog that are digging into those kinds of post already either agree or disagree and I’m not changing anyone’s mind. So it just feels like a fool’s errand to keep trying.
Max Kennerly didn’t get this memo and writes a really nice post today shedding more light on the reality of this epidemic, one that we have not made a real dent into in spite of a lot of smart people trying to help solve the problem.
One issue Max talks about is the crazy paradox of doctors saying, “The problem is defensive medicine. I order my patient tests they don’t need and might subject them to harm because I want to cover myself against lawsuits even though I have malpractice coverage.” Here is one saying almost exactly this. It seems like an unbelievably self-incriminating statement that some doctors blithely give all of the time. They could at least throw us a bone and show enough self-awareness to acknowledge the insanity of it.
I believe, as Max does, that most doctors put their patients first and order the exact amount of testing and treatment they need. In fact, I think defensive medicine is a problem primarily because doctors care so much for their patients, they want what is best for them regardless of the cost. Is this a problem? Maybe on a macro level. But we have bigger problems than the byproducts of doctors caring too much about their patients.
(2018 Update: There is better data now on the idea that doctors are performing unnecessary tests. So maybe some of my “doctors are good people who would not provide unnecessary tests of people to protect themselves” optimism may have been a little bit ill-founded.)
Doctors also practice defensive medicine because they don’t want to be blamed for hurting their patient outside of the litigation fears. Forget lawsuits, can you imagine being blamed for the death of another person? Whether the accuser is right or wrong, there has to be an unbearable pain that comes with that.
Of course, I’m doing a little of the very thing I’m accusing doctors of doing. There are a number of influences that cause doctors to over treat their patients, including some that are purely “fear litigation” related. But those pushing the defensive medicine myth don’t try to untangle or even acknowledge this complexity. They just draw a straight line from unnecessary tests to the Malpractice Lawsuit Dragon.
I think, and this is the first time I realized it, this is a part of why lawyers and victims are losing this public relations war. Lawyers are the mouthpiece for victims (and ourselves, of course). We tend to see everything in cold analytical terms, allowing for gray. The public we are wanting to persuade to see it our way has little time or energy for the problem. They make decisions like how I decided that speed cameras are good. So the simple “defensive medicine costs us billions” argument is probably unbeatable.
Honestly, this was going to be a two sentence post linking Max’s post when this started.