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Most Docs Practice Defensive Medicine

You may have missed this when it first appeared. Experts from Harvard and the University of Southern California say assumptions made by some analysts that defensive medicine is not an important facet of the high cost of healthcare may be wrong. Those assumptions were based on data showing that malpractice reforms instituted in some states did little to reduce healthcare spending. According to the report from the National Center for Policy Analysis (NCPA) about an article in the Wall Street Journal, defensive medicine (“ordering some tests or consultations simply to avoid the appearance of malpractice”) is just as common in states with both low and high malpractice risk. In fact, about 2/3 of doctors in both the low- and high-risk states admitted to practicing defensive medicine. My experience is that the 2/3 figure is probably a very low estimate. Just about every physician I know has ordered a test or consult strictly to “cover his/her/their asses” if something were to go wrong. I am certain it happens tens of thousands of times per day in the US. I can cite many examples of defensive medicine: A young man with chest pain arrives in the ED. After taking a history and examining the patient, the ED MD is 99.95% certain that the patient did not have a heart attack or a pulmonary embolus. But he’s a little short of breath. He remembers a case of a fatal PE with only minimal shortness of breath, orders a blood gas and CT angiogram of the chest. A young girl comes in with lower abdominal pain, no GI symptoms, no fever. The pain...

Conference Coverage: American Academy of Orthopaedic Surgeons 2012

The 2012 annual meeting of the American Academy of Orthopaedic Surgeons was held from February 7-11 in San Francisco. The features below highlight just some of the studies that emerged from the meeting. >> Analyzing Deep SSIs in Total Hip Arthroplasty >> Pain Following TKA Tied to Osteoarthritis >> Are Antibiotics Necessary for Clean Soft Tissue Hand Surgery? >> Defensive Medicine Costly in Orthopaedic Surgery >> Trending Lumbar Spinal Stenosis Surgery Analyzing Deep SSIs in Total Hip Arthroplasty The Particulars: Deep surgical site infections (SSIs) are severe complications that may occur in total hip arthroplasty (THA). Few studies have explored patient- and surgical-related risk factors for SSIs associated with THA. Data Breakdown: A prospective cohort study of 30,491 THA procedures found an incidence rate of 0.51% for deep SSIs. Patient factors associated with deep SSI were female gender, BMI of 30 kg/m2 or higher, and American Society of Anesthesiologist risk score of 3 or greater. Patient factors not associated with an increased risk of SSIs were age, arthritis diagnosis, diabetes, and race. Bilateral THA procedures were associated with a 5.32-times increased risk of SSIs when compared with unilateral THA procedures. Surgeon and hospital case volumes, use of antibiotic cement, fixation method, laminar flow, surgical approach, and fellowship training were not associated with SSIs. Take Home Pearl: Female gender, obesity, chronic medical conditions, and bilateral THA procedures appear to be associated with deep SSIs. Pain Following TKA Tied to Osteoarthritis The Particulars: Little is known regarding the association between objective ratings of preoperative osteoarthritis (OA) and pain and dissatisfaction following total knee arthroplasty (TKA). Data Breakdown: In a study, investigators...

Conference Highlights: The American Academy of Orthopaedic Surgeons 2011

This feature highlights some of the studies that emerged from the 2011 AAOS annual meeting, including data supporting the long-term function of total knee replacement (TKR), imaging costs linked to defensive medicine, PE risks after knee arthroplasty, and the effect of stretching before running. » TKR Improves Function for the Long-Term » PE Risks After Knee Arthroplasty » Are Two TKRs Better Than One? » The Effects of Stretching Before Running » Imaging Costs Linked to Defensive Medicine TKR Improves Function for the Long Term The Particulars: Most patients who undergo total knee replacement (TKR) are between the ages of 60 and 80. More than 90% of these individuals experience a dramatic reduction in knee pain and a significant improvement in their ability to perform common activities. However, questions have been raised about the decline in physical function over the long term despite the absence of implant-related problems. Data Breakdown: Between 1975 and 1989, a study looked at TKRs performed in 128 patients who were living at 20 years follow-up. The average age at operation was 63.8. Of the study participants, 95 could walk at least five blocks when assessed at 20 years follow-up, and 48% reported unlimited walking ability. All but two patients could negotiate up and down stairs without a banister. Only three patients were considered housebound, and no implant failures were observed after 20 years. Take Home Pearls: Elderly recipients of TKR appear to be using their surgically replaced knees for fairly active lifestyles many years after surgery. This study refutes the perception that well-functioning TKRs diminish over time because of an overall declining functional status. PE Risks After...
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