Quote:
Originally Posted by Ledgem
I love how you talk about defensive medicine and are outraged at the idea of ordering unnecessary tests as if they're fairly rare things. I don't say that in a belittling manner - I presume they're fairly uncommon in the Philippines, and the way that you speak about them is refreshing. Defensive medicine is incredibly common in America.
How do you know if a CT or MRI is unnecessary until you run it? Strokes aside, what if the patient has a brain tumor, infection, trauma, aneurysm, multiple sclerosis (less common in the Philippines, I know), and so on? If you don't order them and the patient goes on their way, only to have it discovered later, you could be on the receiving end of a lawsuit for negligence. Sure, your history and physical will correctly indicate that it is unnecessary the majority of the time, but there will be some cases that slip through that would otherwise be caught by the imaging. Should we image 100 people if only two really would have benefitted from it, driving up the costs for everyone? Most people would probably say yes, if it means that their chances of experiencing a missed diagnosis is decreased. The hospital would probably say yes, because an unused imaging machine is wasted space and investment for them. As a result there is little incentive not to order the test, aside from your own conscience. Even then, I wonder what will happen when you miss something that imaging could have caught.
It's true that we're ordering a lot of unnecessary tests in America, and there are more reasons than just defensive medicine. I won't deny that laziness may very well be a part of it. Order enough tests and the differential becomes clearer to you without having to do too much thinking. I agree that we should be more careful about the tests that we choose to run, but those lawsuits are tricky.
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I dislike the idea of defensive medicine, but I guess it's unavoidable in first world countries such as America. But it's harmful to patients of poorer countries in the sense that it drains them financially. In the long run, these patients won't have enough money to maintain their health. Which is why a lot of med schools here teach us to rely more on history and pe and to be cautious when ordering tests, taking into consideration the financial status of the patient and to order the tests only when necessary.
It just irritates me when I see other doctors order ct and mri left and right without first considering the history and PE properly...