Deborah Harrell wrote:
http://www.usatoday.com/news/health/2005-05-31-malpractice-suits_x.htm
<entire article below>
Fear of getting sued leads an alarming number of
doctors to practice "defensive medicine," such as
ordering unnecessary tests and avoiding risky
procedures, a survey found. The practice has been
around for decades, and is no secret to many patients.
But the survey of 824 Pennsylvania doctors suggests it
is surprisingly common, researchers said.
A separate study found that caps on malpractice
damages and other changes in liability law appear to
have less effect on the nation's supply of doctors
than ardent supporters of tort reform contend. The
studies were published in Wednesday's Journal of the
American Medical Association.
Ninety-three percent of the Pennsylvania doctors [from
high-liability specialties] surveyed in 2003 said they
sometimes or often practiced "defensive medicine"
because of malpractice concerns. "That means they
engaged in unsound practices that exposed patients to
potential harm," said Dr. Peter Budetti, a
physician-lawyer and public health professor at
University of Oklahoma Health Sciences Center. He
called the numbers staggering.
"Perhaps the greatest irony is that defensive medicine
may be counterproductive and actually might increase
malpractice risk," said Budetti, who wrote an
accompanying editorial.
[rest snipped by Julia]
So, I'm wondering something now about my own most interesting experience
in a hospital....
I gave birth to twins almost 21 months ago. 10 days before I gave
birth, an ultrasound was performed for the purpose of determining the
position of each fetus. They were both head-down, and I'd given birth
to a fairly large baby (with a huge head!) previously, so my doc and I
were on the same page, vaginal delivery.
I was induced (and if you want a screenful about pitocin + ruptured
amniotic membrane, all you have to do is ask) and the first baby, the
one who'd been lower down for at least a couple of months at that point,
was born without any major incident. She had a really good scream (and
never lost it) and an incredible 1-minute Apgar of 9, IIRC. (At least,
that's incredible for one of *my* babies.... Both the others had lower
1-minute Apgars.)
Then it was time to deliver the second twin. SOP in this case seems to
be, rupture the amniotic sac and deliver. Well, he was in prime
position for delivery, just needed to get a little closer to the cervix
-- and then when his sac was ruptured, he decided he didn't like the
position he'd been in for entirely too long. Attempts to turn him
manually failed, so the doc was left with 2 choices: breech delivery or
quick, unplanned c-section. She opted with the breech delivery, and
apparently shocked the rest of the medical personnel in the room;
apparently, that just isn't *done* at that particular hospital.
Now, I think it was the best thing for everyone directly involved -- it
was over more quickly, once she made the decision, I didn't have an
incision in my abdomen to recover from, and I think it carried less risk
to the baby, given that she'd had some experience in breech deliveries
(just hadn't done it lately). My son's 1-minute Apgar was 4, but he
caught up to his sister at the 5-minute mark, matching her 9 (both had
blue feet for a couple more hours, no biggie), and while there was
concern for awhile that all that stuff might have hurt him, the only
medical problems he's had had nothing to do with his birth. (Reflux.
We're working on slowly weaning him off the Prevacid now....)
So, in that case, what would be the "defensive" action? The breech
delivery or the c-section?
Julia
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