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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Personally to me it all boils down to not so much defensive medicine as it is the stark contrast between health economics of a developed nation and a developing one. In the US I assume it's much, much more easy for a doctor to stick a patient into all the scanning tubes available and likewise stick all kinds of syringes into their antecubitals because there's always some sort of payment going to be available to cover these costs. You have some sort health insurance to cover even the poorest of the poor because your government mandates it, and AFAIK even those who technically lack it still have some sort of limited coverage.
This doesn't apply in third world countries like the Philippines, where 50% of the population can't even pay the rough equivalent of $5 monthly to be covered by the most basic health insurance (PhilHealth), much less pay for a CBC (~$4) or a chest xray ($5-$6 ish).
It's not so much to me defensive medicine as it is the fact that you can make a very good diagnosis assuming you were trained properly, while knowing that most of your patients will struggle to find payment for the tests they need, even more so unnecessary ones. I would gladly cut or waive my PF if it came down to it.