Quote of the week, from Charles Krauthammer (on Obamacare)

[Jarid in Cedar]

Many docs are forced to engage in CYA or defensive medicine knowing the likes of trial lawyers go to be each night hoping for something bad to happen to people. What a life to lead.

Most docs engage in CYA medicine when they don't have a great level of comfort with a patient or don't have enough time to discuss the situation fully. I find that if I take an extra 5 minutes to describe what the likely cause of a problem is versus some of the other things that could be causing it(and a list of additional symptoms that would raise concerns about more dire diagnoses), I end up ordering far fewer tests.

In my case, documentation is my CYA. In an uncertain diagnosis, I document what I think is the likely cause, what are some other possibilities, what our current evaluation will comprise of and what reasons, I will abort this plan and spread the diagnostic net out further. My patients are educated to what symptoms I would want to see them sooner than planned, and if we have 3 visits without a firm diagnosis, we have them see a specialist.

Many docs don't take the time to do this or don't have the bedside presence to be able to pull it off.

The only docs that I sympathize for CYA are ER docs, because they don't have an established rapport with a patient to be able to have the same level of trust in their patients to follow up if the condition persists or worsens.

[Mormon Red Death]

tort reform in medicine gets solved with two words

mandatory arbitration

[Jarid in Cedar]

tort reform in medicine gets solved with two words

mandatory arbitration

We had mandatory arbrtration for the first 5 years I had my practice open, but when we changed malpractice carriers about 2 years ago, they requested that we stop requiring it and let our current arbitration contracts lapse. I was quite suprised by their requests.