Letter to Editor,
Explore This Issue
ACEP Now: Vol 35 – No 08 – August 2016I was somewhat disappointed by the comments from practicing emergency physicians. Their reluctance to implement the test ordering approach suggested by the Choosing Wisely project seemed to be fixed on self-protection at the patient’s (and society’s) expense.
I am sure Dr. Lozanoff is correct when he says more testing results is better survey results, but unnecessary testing also results in an expense, increased incidence of “incidentalomas,” and a sense of empowerment given to the patient. The latter result causes a continual increase in expectations for more testing on subsequent visits. Perhaps better patient education could substitute for unnecessary testing.
Dr. Fisher seems to want immunity from malpractice liability in exchange for more appropriate testing patterns. I do not see how we, as professionals, can disconnect our “rights” (immunity) from our responsibility to “do no (economic) harm.”
Finally, I am not aware of any data that show a clear association between increasing testing and decreasing lawsuits.
Bruce D. Janiak, MD, FACEP, FAAP, professor, Augusta University
One Response to “Opinion: Emergency Physicians’ Reluctance to Implement Choosing Wisely Recommendations Brings Criticism”
August 22, 2016
Pinaki MukherjiAgree with Dr. Janiak’s comments, except that I believe we do have some association between testing and lawsuits. We’re just unclear on whether it’s positive or negative. From 2015 “Does defensive medicine protect doctors against malpractice claims?” the answer from 6 subspecialties seems to be yes. (BMJ. 2015 Nov 4;351:h5786. doi: 10.1136/bmj.h5786).
This far from settles the matter, as overutilization seems to empower patients and improve satisfaction, which then may make them less likely to sue. (Presumably education and communication might also produce a more satisfied patient). Other articles also point out that resource utilization is often high even when perceived risks are low. Perhaps “overutilization” is merely the current standard of care.
Conflicting data would be reports showing increased malpractice costs associated with increased health care utilization, particularly associated with imaging procedures. Imaging begets more imaging begets biopsy begets lawsuit.
So, very happy to support the idea that we should do what’s right for the patient and echo Dr. Janiak’s thoughts. And, there’s nothing stopping policymakers from trying to create safe harbors to adopt the Choosing Wisely campaign, improve the climate of liability in our country, and try to protect our docs while they do the right thing.