3 ms·

A doctor I was talking to recently told me that they do way too many scans in America because of liability concerns that don't exist in other countries. If the

A doctor I was talking to recently told me that they do way too many scans in America because of liability concerns that don't exist in other countries. If there is a tiny chance that a condition might actually be something more serious than the obvious diagnosis they will send you in for a scan to be sure even though the doctor "knows" that it's not.

chris_mahan 14y ago
Wait a minute... Are you saying that because French doctors can't be sued for making a mistake they don't order MRIs? What? you're not saying that? Then why would American doctors order more MRIs? Perhaps to detect those tiny chance conditions, that might actually be more serious? So you're saying that sometimes the MRIs reveal something important about the patient's health? And you're wanting to blame US doctors to find that out? How does the doctor "know" that it's not? Should they not "make sure" instead of just "know"? I think I prefer the US system in that regard.
- danielweber 14y ago
  Your uncalled-for sarcasm is burying several important points. First, when doctors in the US are sued they need to show they met the "standard of care." If every other doctor in your community is doing MRIs, you have to do them to, even if they provide no health benefit to the patient. Even if you think that MRIs are leading to worse patient outcomes, that's not the standard you are being judged by. Second, being sued is a very expensive proposition, even if you did nothing wrong, and doctors are very risk averse of going to court even if they are perfectly confident they did nothing wrong and can prove it. How does the doctor "know" that it's not? Should they not "make sure" instead of just "know"? While they can have benefits, all medicare procedures have costs as well as side-effects. In fact, some procedures can decrease patient outcomes, meaning even if they were absolutely free you wouldn't do them. They still get done, because whenever anyone talks about effectiveness research, someone else has a fit. (If Democrats suggest it, Republicans talk about the government getting between you and your doctor. If Republicans suggest it, Democrats talk about how they are putting profits over patient health.) We can't have the grown-up conversations about what procedures are and aren't worth spending money on, because someone insists that all doctors should "make sure."
  - chris_mahan 14y ago
    I lived in France, and I have relatives, including my sister, who lives in France now (and is a recipient of the French medical establishment's services). I worked for a US HMO for 5 years. I also worked for a US medical malpractice insurance company for 1 year. The points you make are valid, and I agree the system is messed up. Alas, I recognize that all massive systems are messed up and cost a lot more than they should, because large systems introduce inefficiencies. It is possible that the US system is less cost-effective than systems in Europe because of the size of the US population versus that of other European countries. Japan seems to be a hybrid system, and has a population of 125 million or so, but I don't know much about it despite the fact that my wife is Japanese. In the other large-population countries such as China, India, Indonesia, I don't know that things are any better. (As an aside, I don't think sarcasm is ever "called-for".)

chris_mahan 14y ago

Wait a minute... Are you saying that because French doctors can't be sued for making a mistake they don't order MRIs? What? you're not saying that? Then why would American doctors order more MRIs? Perhaps to detect those tiny chance conditions, that might actually be more serious? So you're saying that sometimes the MRIs reveal something important about the patient's health? And you're wanting to blame US doctors to find that out? How does the doctor "know" that it's not? Should they not "make sure" instead of just "know"? I think I prefer the US system in that regard.

danielweber 14y ago
Your uncalled-for sarcasm is burying several important points. First, when doctors in the US are sued they need to show they met the "standard of care." If every other doctor in your community is doing MRIs, you have to do them to, even if they provide no health benefit to the patient. Even if you think that MRIs are leading to worse patient outcomes, that's not the standard you are being judged by. Second, being sued is a very expensive proposition, even if you did nothing wrong, and doctors are very risk averse of going to court even if they are perfectly confident they did nothing wrong and can prove it. How does the doctor "know" that it's not? Should they not "make sure" instead of just "know"? While they can have benefits, all medicare procedures have costs as well as side-effects. In fact, some procedures can decrease patient outcomes, meaning even if they were absolutely free you wouldn't do them. They still get done, because whenever anyone talks about effectiveness research, someone else has a fit. (If Democrats suggest it, Republicans talk about the government getting between you and your doctor. If Republicans suggest it, Democrats talk about how they are putting profits over patient health.) We can't have the grown-up conversations about what procedures are and aren't worth spending money on, because someone insists that all doctors should "make sure."
- chris_mahan 14y ago
  I lived in France, and I have relatives, including my sister, who lives in France now (and is a recipient of the French medical establishment's services). I worked for a US HMO for 5 years. I also worked for a US medical malpractice insurance company for 1 year. The points you make are valid, and I agree the system is messed up. Alas, I recognize that all massive systems are messed up and cost a lot more than they should, because large systems introduce inefficiencies. It is possible that the US system is less cost-effective than systems in Europe because of the size of the US population versus that of other European countries. Japan seems to be a hybrid system, and has a population of 125 million or so, but I don't know much about it despite the fact that my wife is Japanese. In the other large-population countries such as China, India, Indonesia, I don't know that things are any better. (As an aside, I don't think sarcasm is ever "called-for".)