Defensive Medicine Benefits

A visit to the emergency department (ED) is usually associated with negative thoughts by most people. It creates preconceived images of overcrowded waiting rooms and routine long waits for treatment (Jarousse, 2011). From 1996 to 2006, ED visits increased annually from 90.3 million to 119.2 million (32% increase). During this same time period, the number of EDs has declined by 186 facilities creating the age old lower supply and greater demand concept (Crane & Noon, 2011). There are many contributing factors that have led to an increase in ED visits. A few of these key drivers include lack of primary care access, rising of the uninsured population, dwindling mental health services, and the growing elderly

When focusing on the Centers for Medicare and Medicaid Systems strategies for improvement with unnecessary emergency room visits, a major key area is accessibility to health care at the appropriate health care setting. For many years, there has been the perception that the emergency department is the only place for someone who is uninsured or underinsured can go to receive the needed and appropriate health care, and in some situations that may be the case. (Rhodes et al, 2013, p.394) Due to the decreases in reimbursements for the publicly funded, more and more physicians are opting out to treating these patients, thus leading to an increase in emergency department utilization. According to a study conducted by Rhodes, Bisgaier, Lawson, Soglen, Krug, and Haitsma, this is becoming a greater concern for the

The filing of the complaint must be completed within 72 hours of the transfer (Sally Austin, 2011). As a result of this, it has been difficult to see whether or not EMTALA has truly been successfully implemented and effective (Sara Rosenbaum, 2012). Another disadvantage is that EMTALA only requires hospitals to treat “true emergencies”, which are subjective in nature. The last revisions in 2003 for EMTALA by policymakers and CMS limited EMTALA to only patients that arrived to the emergency department, not to other areas of the hospital, such as a doctor’s office appointment or outpatient surgery (Sara Rosenbaum, 2012). Another negative consequence of EMTALA that is not addressed by the law is that emergency department physicians can still be held liable and face malpractice issues by uninsured patients (Singer, 2014). There have been legislative proposals by members of Congress that are working to change this to include physicians as members of the Public Health Services, which would address these concerns (Singer, 2014). These hesitations by physicians has forced some hospitals to close their emergency departments in California to avoid these financial consequences of lawsuits (Friedman, 2011).

The RUC will be able to provide treatment to patients suffering from non-life threatening conditions and the most common illness, including pneumonia and flu, fevers, upper respiratory infections, sprains and strains, lacerations, contusion, and also necessary screening test, such as High Blood Pressure, mammogram, diabetes. Since the late 1980s and early 1990s, hospitals have looked to facilities such as RUCs as a means to reduce rate of inappropriate ED utilizations by triaging patients to less acute settings. The ED is not the most appropriate care setting for many patients, such as elderly patients and young children. Non-urgent patients account for well over 10 percent of the average ED’s caseload, and semi-urgent cases account for another

Defensive medicine takes two main forms: assurance behavior and avoidance behavior. Assurance behavior involves the charging of additional, unnecessary services in order to a)reduce adverse outcomes, b)deter patients from filing medical malpractice claims, or c)provide documented evidence that the practitioner is practicing according to the standard of care, so that if, in the future, legal action is initiated liability can be pre-empted. (David M. Studdert, et al., 2005) Diagnostic defensive medicine practices have a much greater impact on costs that do therapeutic defensive practices. One study conducted by American Academy of Orthopedic Surgeons, showed assurance behavior reported by 92 percent of physician respondents involves ordering test (particularly radiological imaging) performing diagnostic procedures through CT scans, x-rays, MRI studies, ultrasound studies, laboratory testing and referring patients for consultation. The ordering of unnecessary tests can lead to diminishing quality of care and produce emotional distress and necessitate additional invasive or hazardous procedures.

Patients who request for their own doctors should have their wishes respected as a matter of a patient's rights. It does not matter whether those requests occur in the ER or during their hospitalization under the UCR hospitalists. These requests have been routinely ignored, or transmogrified into an ugly

Sometimes it is unethical for us to wait and conduct a baseline when symptoms are too severe.

Defensive medicine has also contributed to the over-utilization of healthcare services. Providers tend to order unnecessary tests, medications, and procedures in order to evade malpractice

A study by the CDC showed that approximately 70 % of emergency department visits can be

A disturbing trend in emergency medicine research is developing due to a reduction in research dollars. Shrinking budgets for research are limiting funds that inform residents of ongoing studies. The result is that people are not aware that they might be subject to experimental medicine and do not have the choice to opt out if they so choose.

Gawande’s (2015) article “Overkill,” suggests that physicians overprescribe drugs and tests which are ultimately unnecessary for patients. To eradicate such behavior, I would implement an electronic health record (EHR) with the following functions: Computerized provider order entry (CPOE) with a clinical decision support system (CDSS) to assist physicians/clinicians (stakeholders) in their medical practice or at hospitals. These functions will help to alleviate redundant tests and make suggestions about treatment. According to HealthIT.gov (2014), CDSS caters chiefly to drugs, laboratory testing, radiology procedures, and helpful clinical literature (HealthIT.gov, 2014).

If they haven’t diagnosed their patient properly and done the proper tests this can pose a major issue; especially if their patient is in tune with their body. Traumatic factures to the patients can result in lawsuits as well. My father has multiple myeloma and there was a direct order to have an open MRI done and that order was not followed. As a result the radiology tech broke his humerus in an attempt to straighten his arm trying to get him into a closed MRI. He successfully sued the hospital. Not performing procedures when they are at their best capacity to can lead to being sued. If they are over-worked or are in emotional turmoil, then it might be in the best overall interests over everyone concerned to turn the procedure over to another

“Hospitals are not only required to care for emergency patients, but they also are required to do so in a timely fashion” (Pozgar, 2010, p. 272). “Hospitals are expected to notify specialty on-call physicians when their particular skills are required in the emergency department. An on-call physician who fails to respond to a request to attend a patient can be liable for injuries suffered by the patient because of his or her failure to respond” (Pozgar, 2010, p. 271). Under the doctrine of Respondeat Superior, hospitals are also liable for the actions of physicians working or on-call in their emergency department.

In 1999, the Institute of Medicine released the first of a series of reports that would ignite a national focus on patient safety and quality of care. This first report, To Err is Human, addressed the fact that healthcare in the United States is not as safe as it should be.

Another idea would be to make sure the patient and doctor go over the procedure, or treatment plan together and sign a contract stating that everyone knows the risks and all questions were asked. I know most doctor offices do this already but it should be strongly enforced