The following is a reader take by an anonymous physician.

Defensive testing is not the same as unnecessary testing. An unnecessary test is one that no one needs. A defensive test is one that almost no one needs.

If you have a patient with a problem who you can diagnose 99% of the time without a test, but 1% of the time you will miss a huge problem, then for most people, that is an unnecessary test. Unless of course they are the 1% who suffer a complication, and who are often very unhappy with their doctor. Some patients will actually benefit from all that testing, though you by definition cannot tell ahead of time who they will be.

Our culture will not accept the fact that there may be patients who have bad medical outcomes that could have been avoided if a test had been done. Our society will not accept a level of medical mistakes that the rest of the world takes for granted as part of the unpredictability of life.

When adverse outcomes lead to unbelievable awards, or at least to a painful defense of a malpractice suit, doctors will do whatever it takes to avoid that. A test can be a type of second opinion. It is no longer possible to defend one’s actions by saying that a physician has used their best judgment in a given situation. So tests will be done.

This is why meaningful control of the cost of medicine will have to go hand in hand with tort reform. It is not good enough to say that we will stop frivolous lawsuits, with the implication that for “real mistakes” the full force of American litigation will still come to bear on those involved. For medical disagreements, regardless of the merits of the case, they should be extracted from the tort system and handed over to administrative systems that will not be subject to the vagaries of the jury system.

There should be equal justice under the law for everyone, not just for patients who are inclined to evoke sympathy in a jury. I suspect also that administrative courts comprised of both medical and legal entities would cut through some of the posturing, grandstanding, and maneuvering, and would be more fair to both defendant and plaintiff.

Our medical system has evolved and developed by tort cases over the last century, with less than stellar results as compared to other first world countries. We’ve used the bloated and expansive legal system to control, adjudicate, assign blame, and award money in medicine, with the end result that our system is broken. Why this has happened is outlined in a nice book, The Death of Common Sense, by Philip Howard.

Despite an unbelievably active plaintiffs bar, compared to the rest of the world, our patients do not seem more well. They are less happy with life in general, and they are afflicted with many societal health problems for which they do not take responsibility (obesity, smoking, alcohol, among others). Our legal system seems to foster this sense of entitlement, and lack of self-reliance, that festers in this as well as other areas of our country.

The myth of the American rugged individualist is just that. My experience with other citizens of the world indicates a higher level of personal responsibility elsewhere, sorry to say, contrary to movie characters and TV heroes. Unfortunately, solving this requires the skills of someone with the country’s interests as a whole in mind, immune to entrenched entities, willing to turn the system on it’s head, revolutionary in nature.

And I don’t see that happening anytime soon.

Submit a reader take for consideration.