Fears of being sued driving doctor bills

The New York Times published a front-page article "Patients' Costs Skyrocket, Specialists' Incomes Soar" on Jan. 19 that sharply criticized the high prices of some medical procedures. The implication was that greed was the factor that drove doctors to do the expensive tests.

Although greed may in some rare cases be involved, a much greater reason why physicians order or do tests that are not always needed is to prevent malpractice suits. For example, a small skin lesion can develop into a serious cancer. Or a simple stomach complaint may be a cancer of the colon. Or a minor chest pain that may be nothing more than a symptom of indigestion can be a sign of heart disease.

So when specialists see patients referred to them by primary care doctors - although there is little likelihood the problem may be serious - they are inclined to do a procedure that makes a definitive diagnosis rather than take a "wait and see" approach and risk a malpractice suit. Until better ways are found to handle malpractice suits, specialists will have an incentive to do expensive and sometimes unnecessary procedures.

Health courts presided over by special malpractice judges have been proposed as an alternative to the adversarial, costly, and flawed system in place now.

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