That’s really not the point of my argument.

My point is that (a) malpractice caps don’t decrease defensive medicine, and (b) in an environment where patients getting good service often determines how much business a provider does, a provider who routinely denies reasonable tests to patients that they themselves wish done will probably see fewer patients.

The science is all well and good. I agree with you on the science … but so what.

If the patient is understanding of the low risk and comfortable with it, then fine she doesn’t need a workup, but if she isn’t, then she’s going to get tested in our system in any state in the union. Not because of defensive medicine but because doctors want to stay in business.

The point you hit on is whether that test is needed or not. In nearly every case with an 18 year old girl the test is not needed….reassurance and a re-visit are what is needed, but it’s very hard to convince them of that because of the pervasive fear of breast cancer in women.

I ask all my patients if they know what the most common cause of death is in women, and nearly all say it’s breast cancer when in fact it’s heart disease that kills more than 10 times as many women as breast cancer.

If the patient is 40 and presents with a new lump then mammography and ultrasound are the way to go as the risk for Breast cancer is now significantly higher than in an 18 year old. To imply that the u/s is truly the first step for an 18y/o I think is wrong.

If, as you admit, defensive medicine exists because “nobody wants to get sued,” then you are admitting that caps don’t work.

As a practicing doctor, I’m not worried about getting sued at all … I am worried about keeping the patient.

If I’m a dick and I keep saying “no you don’t need that” in a way that puts the patient off, I’ll soon spend very lonely days. Now sometimes I can convince a patient that a test is not just not necessary but a bad idea … whole body CT scanning for example.

But the young girl with the breast lump … she’s gonna get tested by almost every doctor almost every time … not because they’re afraid of getting sued I hope, but because they’re afraid of her having breast cancer and not doing anything about it.

To tell her she doesn’t need a test that she wants in a case like that is radical indifference to the needs of your patient.

So lets stop the smoke and blather about the “costs of defensive medicine.”

The only thing caps can do is decrease the average award from jury trials and settlements (which by the way are cases where both sides agree that something indefensible took place).

So the purpose of the cap is to keep awards down for people with legitimate cases as determined by juries and insurance companies.

Woo hoo!

Matthew, granted it is easier to “make stuff up”, but how is that figure ascertained?

Evan, nobody here wants to address the fact they yawn at – that 10 – 20% of every health care dollar goes to pure bureaucratic waste. That’s about three times as much as the highest total cost for “malpractice”, including the made up “defenisve medicine” figure. The concern here is *not* about keeping health care costs down – it is about keeping physician income up.

Besides, if we “follow the bouncing ball” and accept the latest argument that 6-8% of health care costs are “defensive medicine”, we’re brought right back to the fact that damages caps are about recovery in the most meritorious cases with the most severely damaged victims of malpractice – and won’t have any effect on “frivolous” or unsubstantiated claims, and thus won’t have any impact on “defensive medicine”. But perhaps that’s okay, because as MJL noted, when he practices “defensive medicine” he gets paid.

If “defensive medicine” is such a cost … then it’s still being practiced in the areas with the caps and hence, the only change that will take place is in insurance rates, and in fact we have a cap in Nevada and we’re still not seeing that.

So I’m agnostic about whether caps solve any problems, and as scientists, doctors as a group should be as well.

If someone has a political beef to say that caps are great because of this political reason or that, that’s fine, but where there is empirical evidence, we are obligated to either explain why it isn’t germane or deal with what it tells us.

From what I can tell the evidence so far is that caps do very little, if anything.

Can anyone with a straight face tell me that if we got rid of all malpractice suits overnight, health care spending would go down $100 billion? Go ahead I dare you!