[hombre_fatal]

Out of curiosity, how is a physician negligent if decades of exposure to hypertension/LDL/smoking/diabetes (the variables on that calculator) give you a heart attack or stroke?

By the time you're put on a statin, for example, you've already had decades of exposure due to your lifestyle.

Also, I don't believe the claim that physicians don't care about CVD risk in patients <40yo including high blood pressure and high cholesterol.

[zamadatix]

Flip the issue to something less polarizing and it should appear this is a very separate scenario from what GP is talking about (even if perhaps you still don't agree it should be malpractice for some reason):

1) You go in after feeling confused and have a headache after falling from a skateboard with no helmet. The ER sends you home not having checked anything or any notes to watch out for because they think you're too young to have problems from a fall (despite many young people having problems after a fall each year). At home you die because of a brain bleed.

vs.

2) You go in after feeling confused and have a headache after falling from a skateboard with no helmet. The ER runs some tests, sees the problem, and prescribes the best course of treatment given this information. Despite this you still die or have lasting effects on your brain.

Despite the doctors not fully remedying your problem in both situations only situation 1 involves negligence for a malpractice claim because the problem isn't the outcome, it's the quality of treatment not meeting the minimum levels. Flip the scenario specifics back and what GP is saying is that it isn't considered negligence to say "you're under 40, you're fine, go home" instead of "you could seriously be having a problem. We should put you on a statin and talk over the risks/symptoms of a heart attack" because the standard of care (sort of one measurement for what's a negligent treatment action) says the calculator defines the appropriate treatment and the calculator doesn't even work for those <40. What GP is not implying is doctors are negligent just because you still had a heart attack anyways.

[adastra22]

Any ER would check for a concussion in that circumstance, as I can attest from experience.

[zamadatix]

Almost certainly. That's why not doing so is used as a clear example of malpractice and negligence - the standard of care says to check for those kinds of issues given the situation and that's what nearly every doctor will therefore do.

[adastra22]

Concussion isn’t age related though, so the circumstance isn’t comparable.

[rcxdude]

Falling certainly carries more health risks as you're older, but young people aren't immune, and the same is true for heart attacks. That's the point of the analogy. The skater concussion scenario is obviously ridiculous to highlight how the heart attack scenario is also ridiculous.

[zamadatix]

(separating this out)

I agree with you heavily here: "Also, I don't believe the claim that physicians don't care about CVD risk in patients <40yo including high blood pressure and high cholesterol."

Seems odd over all. My physician, unprompted, wanted to put me on a statin when I was very healthy and in my early 30s just to lower my risk as my cholesterol numbers were trending up at the time. Whether or not this calculator actually works for those under 40, physicians certainly still prescribe statins, evaluate heart health risks, and communicate on the dangers of poor heart health to individuals all the time anyways.

[hgomersall]

Almost all ailments can be mitigated to some extent by lifestyle choices. Is anyone that doesn't make the best possible choices for the particular ailment responsible for their situation?

[hombre_fatal]

The question in this context is whether they are less responsible for their lifestyle choices than their physician.

We're talking about the variables in the calculator: blood pressure, cholesterol, smoking, and diabetes.

Which one of those is the physician more responsible for than the patient?