Dr. Martin Hash Podcast

So-called, “defensive medicine” is speculation that high medical costs are a result of unneeded medical tests & procedures performed on patients to avoid lawsuits. The reality is that there are two perverse incentives for extraneous medical attention: first, since both insurance & Medicare pay the doctor based on what they do and not what they say, doctors must do something, and the more somethings they do, like labs & imaging, the more they're paid. Then there's the liability aspect of medicine: many tests are performed simply so that the doctor does not have to explain why they weren't. Sometimes there's the threat of a remote possibility that they might get sued, but mostly it's a doctor-to-doctor criticism: one doctor thinking a test should be performed and censoring another doctor for not doing so.

To solve the first problem, doctors should get a set fee for an appointment, and if they do order investigative activities, they should receive no further renumeration for those except to cover the basic cost. Secondly, “Standard of Care” rules should protect doctors: if they perform to the Standard of Care, they are indemnified from lawsuits. Both of these solutions are being implemented to one degree or another by the organizations that are cost sensitive; Medicare & insurance, but because medicine is doled out State by State, where doctor's licenses aren't even valid in other States, the haphazardness of the attempts to cost-contain are often thwarted. A uniform national Medical License, medical insurance, and governing body has long been needed. It's only prevented by vested interests & gate-keepers, not by what's best for patients.