[lit-ideas] Re: Here's a new spin on preventative medicine

On May 30, 2008, at 1:02 PM, Julie Krueger wrote:
> "It means that doctors are practicing what they call preventative medicine. In other words, if you think somebody's going to sue you, if you're in a litigious society, then you'll take extra care by prescribing more and more either procedures, or whatever it may be."
Simultaneously true and false! American medical guidelines, if properly followed, are a set of treatment "tree branches" designed so that doctors will not be sued. Following the guidelines, a doctor can say, "I did X and Y and Z. I'm clear." Sometimes, as Bush states, these steps involve several unnecessary procedures.
Another way in which the Bush statement is true: good doctors will avoid working in primitive facilities because the risk of being sued increases, even if the patient is referred to a larger hospital elsewhere.
There are many scams in medicine, and some are actually abetted by its being so highly regulated. There are scams at the provider level and scams at the institutional level. There are even scams at the federal level with Pete Stark's laws, which allow sponsors to enslave foreign doctors.
For an institutional scam example: if hospital X has a cardiac-cath lab (an expensive but lucrative facility) they may "tend" to perform stress tests that lead their patients to the cardiac-cath lab at their hospital. Big surprise here: if you hang around a barbershop, you might end up with a haircut.
For a provider scam example: if a doctor owns his or her clinic and has a conspiring cardiologist, he or she may run bogus stress tests at the clinic that "tend" to send people to the conspiring cardiologist for consult. The cardiologist may then send the poor patients for another stress test at hospital X (above) where ... ooops ... they get a cardiac cath.
Cardiac caths are not always perfectly performed, and so the patient may get infected or worse. See Paddy Chayefsky's _The Hospital_ for other scenarios. "At 7:30 a.m. a patient named Guernsey was admitted to the hospital..." 

Yours in limited knowledge of the subject,
The Paraclete of Kaborka
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