[dwolfson]

I find it slightly disingenuous to write a comprehensive article on wasteful medical care and yet barely mention the extremely litigious environment that doctors face.

It's not just doctors that remember that one patient that didn't get scanned. Lawyers do, too.

[Frondo]

One of the stats that came out of the Obamacare health care industry discussion in 2009-2010 was that medical tort reform would only reduce medical spending about 1-2% per year.

[limeyx]

I think though that that only accounts for the money that would be saved in the lawsuit payouts.

It doesn't include all the costs of un-necessary tests doctors do because they fear getting sued. No matter how big or small the payout in a lawsuit, that's not a good place to be and is going to leave a black mark on a dr's record no matter the outcome.

[jobu]

The legal complications around malpractice and malpractice insurance are unfortunate, but they only reinforce the already perverse financial incentives that doctors have for ordering more tests and procedures.

The theme for the article was that doctors need to slow down and spend more time listening to patients. If anything that should reduce the legal risks of inadequate or inappropriate care.

[dwolfson]

I agree, the financial incentives must be repaired. I just think it is odd that the malpractice angle wasn't mentioned. Dr. Gawande is surely aware of it.

And yes, I'm sure doctors and patients would both agree that docs need to slow down and spend more time listening to patients. As a solution, Dr. Gawande proposes compensation based on quality of care (rather than production). In theory, this seems to make most sense - but I have yet to see a practical way of assessing "quality." What stops doctors from refusing to see sicker patients? Is a doctor at fault if the patient doesn't follow his advice?

[rebootthesystem]

The disconnect between ideology and reality in some of these discussions is sometimes remarcable. This "perverse financial objective" you talk about is imaginary. My wife is a doctor. She sometimes lives in fear of not having ordered this or that test. What she pays for insurance could probably support the royal family of some small countries. It's absolutely infuriating that doctors in the US can't focus on patient care and have to worry about being sued out of existence. Imagine if you, as a coder, had to exist under similar conditions.