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Re: NYTimes.com Article: The Doctor's World: Take Two Torts and Call Me in the Morning From: art fougner, md (evsono@pipeline.com) Wed Dec 15 04:58:32 2004 Messages sorted by: [ date ][ thread ][ subject ][ author ] Next message: Robert J. Carpenter, Jr. MD: "Re: Breech" Previous message: Braun, R. Daniel: "Re: breech" Screening mammography in our area has become increasingly unavailable. While a sensitivity of 85% is statistically admirable, the 15% misses result in liability exposure. (Hence the cya's, Zach.) Add to this a reimbursement rate which in quality labs in NYC does not cover the costs, it's no wonder labs are closing and others have 6 month or more wait time for appointments ( doubtless to accomodate folks willing to pay cash.) It doesn't stop here, for radiology residents are avoiding fellowships in breast imaging. Who can blame them? Women's Healthcare generates two of the leading causes of action - CP and Missed Breast Cancer. I don't suppose NOW will agitate for Ob-Gyn's any time soon. Oh one more thing - MRI for breast cancer. In the NEJM article, mammography was a poor second to MRI in the diagnosis of breast cancer in BRCA gene positive patients. However, the sensitivity of MRI was 80% which of course means that in the highest risk patients, imaging would miss 20% of the cancers. Stay tuned... art At Tue, 14 Dec 2004, Zachariah Newton wrote: > >Using screening mammography, as an example: > >The proportion of imaging reports that include recommendation for immediate >further, and more complex, imaging studies is disproportionate to the >probability/possibility ratio of malignant disease. >There is less frequent recommendation for 3-6 month comparative imaging for >gray area situations. > >It goes way beyond CYA by the level of cost for the recommended follow-up. > >I am sickened by the profligate expansion of forced imaging referrals by the >self-serving wording of radiologists reports. Some are clearly appropriate. >I am addressing the overkill. > >In mammography, the report of a solid mass after breast sonography with >recommendation of needle biopsy by the radiologist results in the patient >with benign report still having a residual mass lesion. Does that result in >another dance on next imaging assessment vs initial excisional biopsy by a >breast surgeon? > >We are denied the publication of rates in outcome by various approaches to >common issues from competing resources. It is time for transparency. > >Zach Newton >Z. B. Newton, III, M.D. >Atlanta/Gyn > >-- > >>>----- Original Message ----- >From: "art fougner, md" <evsono@pipeline.com> >To: "Multiple recipients of list OB-GYN-L" <ob-gyn-l@dns.obgyn.net> >Sent: Tuesday, December 14, 2004 7:44 PM >Subject: Re: NYTimes.com Article: The Doctor's World: Take Two Torts and >Call Me in the Morning > >> At Tue, 14 Dec 2004, rmodugno@aol.com wrote: >> >>>"Mr. Edwards may have been among those who got extra tests. >>>Dr. Edmundson said that when Mr. Edwards once fainted in >>>1996, two years before he was Dr. Edmundson's patient, a >>>neurologist found no serious medical reason for the episode >>>and Mr. Edwards was then referred to a cardiologist. It was >>>a more extensive work-up than "most people would have" >> >> In NYC with an abundance of high profile plaintiffs' attorneys ( >> including one Sheldon Silver, the Speaker of the NY State Assembly and >> avowed opponent ot tort reform), everyone has easy access to a trial >> lawyer. Therefore, a considerable number of patients receive extra >> tests, office visits, and procedures lest some detail be omitted which >> may later prove costly in a courtroom. These indeed prove costly but >> have not made a dent in NY malpractice premiums. The indirect costs of >> malpractice to society are rarely considered, yet these are all too true >> costs which must be contained. And they affect us all. >> >> art >> >> -- >> art fougner, md >> ich bin ein New Yorker >> -- art fougner, md ich bin ein New Yorker Next message: Robert J. Carpenter, Jr. MD: "Re: Breech" Previous message: Braun, R. Daniel: "Re: breech"

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