Here are five spine surgeon leaders discussing defensive medicine. Ask Spine Surgeons is a weekly series of questions posed to spine surgeons around the country about clinical, business and policy issues affecting spine care. We invite all spine surgeon and specialist responses. Next week's question: How often do you practice defensive medicine?
Please send responses to Laura Miller at laura@beckershealthcare.com by Wednesday, August 15, at 5pm CST.
Dennis Crandall, MD, Founder and Medical Director of Sonoran Spine Center, Mesa, Ariz.: Each patient encounter has elements of defensive medicine. These include extra dictation, withholding treatments, suggesting treatments, extra imaging, excessive consults, extra office staff to do all the extra work, etc.
Ara Deukmedjian, MD, Founder, Deuk Spine Institute, Melbourne, Fla.: Often. All physicians do it whether or not they realize it. It may come in the form of an unnecessary consult to a specialist or an admission to the hospital or testing ordered. There are even more ways to practice defensive medicine. The biggest reason for malpractice claims is not the lawyers as so many believe, but instead it is really due to doctors throwing their "competition" under the bus in front of the patient. Just remember, a malpractice claim is nonviable unless a colleague signs an affidavit stating a doctor's care has fallen below the standard and that this resulted in an injury. If you are a practicing physician and you receive a malpractice claim, it is most likely because one of your competitors nearby has told your patient (during a second opinion) that you "screwed up" their care and this will undermine your patient's confidence in you and your past treatment of that patient.
I don't understand why some doctors think it is "ok" to badmouth their competition as it is unprofessional and very damaging. I do understand medicine is very competitive and some of these physicians may feel threatened by their colleagues but intentionally damaging the reputation of a colleague to a mutual patient is not an acceptable form of competition and should be refrained from. If you want to beat your competition then do it by providing better patient care with better outcomes. If we could instantly get all physicians to stop badmouthing their competitors to patients, medical malpractice would likely vanish overnight.
Walter Eckman, MD, Founder, Aurora Spine Center, Tupelu, Miss.: Infrequently.
Richard Kube, MD, Founder & CEO, Prairie Spine and Pain Institute, Peoria, Ill.: We probably practice some form of defensive medicine daily. Some of this is in the form of ordering tests and studies a little more aggressively than I might usually do. Some patients will come in demanding an MRI for example. Many times it is unnecessary, or at least it is too early in the evaluation process to consider one. If the patient is very demanding, we often accommodate to avoid any potential for a "failure to diagnose." The other more frequent example is the dramatic increase in documentation. This affects our direct overhead as staff time is required to perform these tasks. Not a phone call goes by without some type of note going into the patient chart regarding the conversation. There is just a larger amount of overall time spent documenting and carefully choosing words than before which takes time away from patient care or adds to the work day.
Raj Rao, MD, Director of Spine Surgery, Medical College of Wisconsin, Milwaukee: On a daily basis — in the way we are required to approach our patients, the way we order investigations and in the inordinate time we spend in documentation that means little to the actual care of patients.
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Please send responses to Laura Miller at laura@beckershealthcare.com by Wednesday, August 15, at 5pm CST.
Q: How often do you practice defensive medicine?
Dennis Crandall, MD, Founder and Medical Director of Sonoran Spine Center, Mesa, Ariz.: Each patient encounter has elements of defensive medicine. These include extra dictation, withholding treatments, suggesting treatments, extra imaging, excessive consults, extra office staff to do all the extra work, etc.
Ara Deukmedjian, MD, Founder, Deuk Spine Institute, Melbourne, Fla.: Often. All physicians do it whether or not they realize it. It may come in the form of an unnecessary consult to a specialist or an admission to the hospital or testing ordered. There are even more ways to practice defensive medicine. The biggest reason for malpractice claims is not the lawyers as so many believe, but instead it is really due to doctors throwing their "competition" under the bus in front of the patient. Just remember, a malpractice claim is nonviable unless a colleague signs an affidavit stating a doctor's care has fallen below the standard and that this resulted in an injury. If you are a practicing physician and you receive a malpractice claim, it is most likely because one of your competitors nearby has told your patient (during a second opinion) that you "screwed up" their care and this will undermine your patient's confidence in you and your past treatment of that patient.
I don't understand why some doctors think it is "ok" to badmouth their competition as it is unprofessional and very damaging. I do understand medicine is very competitive and some of these physicians may feel threatened by their colleagues but intentionally damaging the reputation of a colleague to a mutual patient is not an acceptable form of competition and should be refrained from. If you want to beat your competition then do it by providing better patient care with better outcomes. If we could instantly get all physicians to stop badmouthing their competitors to patients, medical malpractice would likely vanish overnight.
Walter Eckman, MD, Founder, Aurora Spine Center, Tupelu, Miss.: Infrequently.
Richard Kube, MD, Founder & CEO, Prairie Spine and Pain Institute, Peoria, Ill.: We probably practice some form of defensive medicine daily. Some of this is in the form of ordering tests and studies a little more aggressively than I might usually do. Some patients will come in demanding an MRI for example. Many times it is unnecessary, or at least it is too early in the evaluation process to consider one. If the patient is very demanding, we often accommodate to avoid any potential for a "failure to diagnose." The other more frequent example is the dramatic increase in documentation. This affects our direct overhead as staff time is required to perform these tasks. Not a phone call goes by without some type of note going into the patient chart regarding the conversation. There is just a larger amount of overall time spent documenting and carefully choosing words than before which takes time away from patient care or adds to the work day.
Raj Rao, MD, Director of Spine Surgery, Medical College of Wisconsin, Milwaukee: On a daily basis — in the way we are required to approach our patients, the way we order investigations and in the inordinate time we spend in documentation that means little to the actual care of patients.
More Articles on Spine Surgeons:
5 Spine Surgeons on How Congress Should Proceed With Healthcare Reform
4 Spine Surgeons on Bundled Payments in the Future
5 Spine Surgeons on the Individual Mandate's Impact