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At least 19 recordsLinked to original sources
PubMed1978

The problem of defensive medicine.

Defensive medicine--the use of diagnostic and end-treatment measures explicitly for the purposes of averting malpractice suits--is frequently cited as one of the least desirable effects of the current rise in medical litigation. Many physicians and policy-makers claim that defensive medicine is responsible not only for the increasing costs of health care but the exposing of patients to significant risks of harm from unnecessary procedures. Very little solid information is available about defensive medicine. The studies that have been conducted have been fraught with statistical difficulties and are by no means definitive. Even more important than the issue of defensive medicine is the more basic problem of our system of compensation for medical injuries.

Adult↗
PubMed1992

["Essential laboratory tests" in primary care medicine--experiences in Comprehensive Medicine, National Defense Medical College].

The "essential laboratory tests" were applied to 1,026 new patients visiting the outpatient unit of Comprehensive Medicine, National Defense Medical College, to determine the usefulness of these tests in primary care medicine. The "essential laboratory tests" have contributed to the establishment of the initial diagnosis or confirmation of the "tentative initial diagnosis", and to the estimation of the nature or degree of seriousness of the disease. In addition, other diseases not related to the patient's chief complaint could be screened in 32% of the new patients examined with these tests. The "essential laboratory tests" were also found to be useful for the estimation of the presence of malignant tumors in 12 patients with various kinds of malignancies as well as the estimation or evaluation for such conditions as infection or inflammation, anemia, liver or renal dysfunction, and the ambulatory screening of metabolic diseases including hyperlipidemia, liver or urinary tract diseases. In conclusion, simultaneous performance of the "essential laboratory tests" with the history taking and the physical examination will provide important medical information in primary care medicine.

Clinical Laboratory Techniques↗
PubMed1975

Protection against malpractice litigation.

Malpractice insurance costs are based on loss experience and defenses of expenses. Physicians in the high-risk category are in that position because, as a group, they have a high frequency of claims, a high average cost, or both. True, "defensive medicine" is the best way to minimize the risks. This does not mean ordering unnecessary tests or refusal of essential treatment. Rather, it is the habit of exercising extra care and foresight to avoid medical hazards and to apply prompt remedial measures when they occur. It means being aware of the patient's personality and needs. It means taking time to talk to the patient about proposed procedures and their risks. This kind of "defensive medicine" offers the best hope for reducing the frequency and cost of claims that result in the present critical malpractice problems.

Communication↗
PubMed1977

PSRO and the dissolution of the malpractice suit.

The effect of PSRO on the practice of defensive medicine and the effect of the civil immunity provision on the numbers of malpractice suits may well be substantial. Cost savings in terms of control of overutilization and of the potential for patient injury engendered by that overutilization will ensue. While substantial, those effects will be small compared to the effect of PSRO on the present medical malpractice system. As a social system, malpractice has two positive purposes. It serves as a measure of quality control on outcomes of medical care, and it serves to compensate people for injuries received in medically related situations. How well it serves these purposes is unknown, but what few data exist indicate that it does not significantly enhance the quality of care nor provide an efficient method of compensation. It exists in theory because it is the final check and balance on physician practice--the only existing control on the outcomes of care. Until some system other than malpractice could be conceived which was at least as efficient in outcomes control, malpractice was destined to continue, and no other method of patient compensation could be considered seriously since the compensation and quality control aspects of malpractice were so inextricably bound. With the advent of PSRO, another means of outcomes control came into existence, and as PSRO becomes operational nationwide, that system will prove an efficient and effective system of control over the quality of outcomes of medical care. Within the environment of PSRO, malpractice as a system of outcomes control has little reason to exist, and its worth as a system of patient compensation can be reexamined. It is within the framework of PSRO that other systems of compensation of the injured patient can be considered and developed--systems hopefully more just and more efficient than malpractice. This is the greatest impact PSRO will have on malpractice. It is, of course, a long-term process, and one which will not produce immediate results. In fact, the role of PSRO in effecting a change in patient compensation may never be recognized directly. It is only within the existence of a working system controlling the quality of outcomes of medical care that the injustices of the malpractice system can be righted and alternatives to that system can be considered.

Defensive Medicine↗
PubMed1978

Effective utilization of clinical laboratories.

Effective utilization of clinical laboratories requires that underutilization, overutilization, and malutilization be appreciated and eliminated or reduced. Optimal patient care service, although subjective to a major extent, is reflected in terms of outcome and cost. Increased per diem charges, reduced hospital stay, and increased laboratory workload over the past decade all require each laboratory to examine its internal operations to achieve economy and efficiency as well as maximal effectiveness. Increased research and development, an active managerial role on the part of pathologists, internal self-assessment, and an aggressive response to sophisticated scientific and clinical laboratory data base requirements are not only desirable but essential. The importance of undergraduate and graduate medical education in laboratory medicine to insure understanding as well as effective utilization is stressed. The costs and limitations as well as the accuracy, precision, sensitivity, specificity, and pitfalls of measurements and examinations must also be fully appreciated. Medical malpractice and defensive medicine and the use of critical values, emergency and routine services, and an active clinical role by the pathologist are of the utmost value in assuring effective utilization of the laboratory. A model for the optimal use of the laboratory including economy and efficiency has been achieved in the blood bank in regard to optimal hemotherapy for elective surgery, assuring superior patient care in a cost effective and safe manner.

Clinical Laboratory Techniques↗
PubMed1992

Why physicians should not do ethics consults.

Increasing complexities facing physicians negotiating the bedside decision continue to fuel the debate over who is the appropriate party to offer ethics consults, should one be needed, during the decision-making process. Some very good arguments have been put forth on behalf of clinical ethicists as being the proper and best party to engage in ethics consultations. However, serious questions remain about the role of the clinical ethicist and his ability to provide the necessary level of objectivity called for in an ethics consult. I argue that the clinician's professional psyche, or mode of thinking as a professional, leaves him little room to maneuver as an objective and detached third party ethics consultant. Several factors are cited and discussed that greatly influence the analyses applied to a case problem by physicians. The most formidable of these factors are habits and the practice of defensive medicine. I conclude that clinical ethicists are less suited for the overall tasks required of an objective consultant in medical cases that appear to involve insurmountable ethical issues.

Decision Making↗
PubMed1992

Medical malpractice: a nonadversarial suggestion.

BACKGROUND: The current legal system for prosecuting medical malpractice claims has bred widespread discontent. It has increased costs, jeopardized the delivery of necessary medical services, and corroded the physician-patient relationship with mistrust and poor morale. METHODS: Analysis of fairness of compensation awards and deterrence of substandard medical services under the current system. RESULTS: Compensation awards are inconsistent and unfairly contingent on irrational, adventitious factors. The current system does not seem to have had a significant effect on detering poor medical practice or on improving medical practice in general. CONCLUSIONS: An alternative to the current litigation-oriented medical malpractice system should be established and centered around a four-member Medical Malpractice Tribunal composed of a general physician, an expert physician in the specialty area of the claim, an attorney, and a lay person. This tribunal would be empowered to investigate malpractice claims by gathering evidence and taking testimony from parties, experts, and witnesses. The tribunal could employ a table of treatment-related injuries in making findings as to physician liability and victim compensation. Such a system, through predictability, would likely increase malpractice prevention while decreasing legal costs and also costs associated with defensive medicine. Deterrence could be served by giving the tribunal power to recommend sanctions against substandard providers to appropriate licensing and disciplinary bodies and by requiring those found guilty of malpractice to contribute subsidies to a compensation fund.

Insurance, Liability↗
PubMed1992

The failure of a preprinted order form to alter physicians' antimicrobial prescribing pattern.

Use of antimicrobial agents is highly effective in reduction of morbidity and mortality due to infectious disease. There is, however, evidence that the use of such agents is frequently inappropriate worldwide. Several methods were tried to rationalize the use, and, among these, the preprinted order form (P.O.F.) offered the simplest and most efficient way. We studied the use of the P.O.F. in Siriraj Hospital, Bangkok Thailand, where there was overuse of antimicrobial agents using a historical-controlled intervention study. In period I (no P.O.F.), the antimicrobial overuse was 35 per cent, and this was not reduced by using the P.O.F. in period II (32%), which was one year apart. There was no difference in overuse after adjustment for differences in base-line characteristics which were thought to affect antimicrobial prescriptions i.e. physicians' workload, physicians' knowledge and the method of diagnosis of infectious disease. Reasons for failure of the P.O.F. in unclear. Misdiagnosis was unlikely since the correct diagnosis as revised by attending physicians and specialists was as high as 83 per cent. The fear of malpractice suits was also not the reason because defensive medicine is not a problem in Thailand. The nature of the diseases, which lower the threshold to treat, the clinical immaturity and other unknown factors were thought to play a part in deviation from responsibility to perform according to written-justification.

Adult↗
PubMed1992

Costs and coverage. Pressures toward health care reform.

Signs of discontent with the health care system are growing. Calls for health care reform are largely motivated by the continued increase in health care costs and the large number of people without adequate health insurance. For the past 20 years, health care spending has risen at rates higher than the gross national product. As many as 35 million people are without health insurance. As proposals for health care reform are developed, it is useful to understand the roots of the cost problem. Causes of spiraling health care costs include "market failure" in the health care market, expansion in technology, excessive administrative costs, unnecessary care and defensive medicine, increased patient complexity, excess capacity within the health care system, and low productivity. Attempts to control costs, by the federal government for the Medicare program and then by the private sector, have to date been mostly unsuccessful. New proposals for health care reform are proliferating, and important changes in the health care system are likely.

Delivery of Health Care↗
PubMedDate not supplied

Medical legal aspects of clinical monitoring.

Modern laboratory technology has spawned a plethora of techniques for measuring and monitoring drug concentrations and body constituents; but the availability and frequent over-use of these determinations, some of which are exotic and require specialized personnel and expensive apparatus have further escalated the already high cost of medical care in several ways. The specter of medical malpractice suits has compelled the physician to practice defensive medicine including ordering unnecessary monitoring procedures, particularly for drug levels. Further impetus has been superadded by the courts and state legislatures; for example, phenylketonuria (PKU) determinations are mandatory in almost all states. Court rulings have held that "common knowledge" not expert testimony, may be all that is necessary to hold the doctor culpable for not ordering a test; nor is expert testimony necessarily required if the Physicians Desk Reference (PDR) or drug company insert recommends that certain tests or monitoring procedures be performed and the doctor fails to comply. (PSRO) programs will force further conformity, leave less to the discretion of the physician and place the government in an ever more regulatory role. Professional societies should take cognizance of the impropriety and danger of the government dictating diagnosis and treatment and should launch a vigorous program to scrutinize pending regulatory legislation and to make official and informed representations to appropriate legislators.

Adult↗