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A comment on The Jones Act in Hawaii: Ed Case and Jim O'Keefe Object to American Worker Requirments.

kat — Wed, 25 Nov 2009 19:50:52 GMT

Here's my opinion...my husband used to work for O'keefe & Sons Bakery. Yes they did anticipate the cost of shipping to go up; however, that was not the SOLE reason for the demise of his business. It was due to his extra marital affairs with his ex-wifes best friend. Let's be realistic, it cost more to fund a girlfriend than his business.

A comment on Isn't Tort Reform Only About Frivolous Cases?

ian lin — Mon, 16 Nov 2009 12:28:07 GMT

Sorry, meant to say in first sentence NOT in favor of caps.

A comment on Isn't Tort Reform Only About Frivolous Cases?

ian lin — Mon, 16 Nov 2009 12:15:02 GMT

Just to clarify, my comment is intended to say that I'm in favor of caps on damages. I clearly state that I think it hurts certain people. But I'm referring to whether or not defensive medicine is good medicine.

I'll give three scenarios to try and illustrate my point:

1. First scenario involves Dr. A. He just came off a case involving removing the wrong ovary (as discussed above). Now he's checking and double checking before operating his next patient. The hospital also instills new measures involving multiple nurses making the same checks. This does increase costs, but I'd argue that this is what they should have been doing in the first place. While this can be considered defensive medicine, I think it's good medicine.

2. Scenario 2 involves Dr. B and patient B. Patient B goes to the doctor's office, saying that he's having fatigue. Keep in mind, fatigue is a very vague symptom. It can be a symptom for nearly every single disease out there. (as an experiment, ask your doctor what he/she thinks about fatigue the next time you're in their office).

Dr. B. does a thorough history taking and physical exam (and I'll admit this doesn't always happen in the real world, but it should). Dr. B. upon questioning also finds out that patient B has been having blood in the stool, so he refers him for lab tests and to a gastroenterologist. A diagnosis of bleeding stomach cancer is found, which explains the fatigue, and the patient is sent for the appropriate treatments.

The lab tests and referral are all expensive, but this isn't defensive medicine. This is good medicine, and the doctor should be liable if he didn't proceed as illustrated.

3. Scenario 3 will involve Dr. C. and patient C. Patient C reads patient B's web blog about being diagnosed with stomach cancer with fatigue as the presenting symptom. Patient C thinks, "well, I've been tired too." So he goes to see Dr. C. Dr. C does the same thorough history taking and physical exam, and aside from fatigue, there is no other symptom or abnormal physical finding with patient C.

Dr. C. informs patient C that he doesn't find any abnormal findings. He also correctly informs him that less than 1% of cases of fatigue are due to serious conditions such as cancer, and it is a very ambiguous symptom (unlike scenerio 1, you either removed the wrong ovary or you didn't).

However patient C, concerned about gastric cancer insists on labs, CT scans, a referral to a specialist to truly rule out stomach cancer.

What does Dr. C do? What should he do? What would you do if you were Dr. C?

....

He does what tens of thousands of docs do every day across the country. He figures that ordering the tests and referral poses very little financial cost to him. He also figures that should patient C be the less than 1% that does have stomach cancer, he could face a costly lawsuit. So there's really no major disincentive for Dr. C. to send patient C for all the tests that he had requested.

So this scenario is defensive medicine, and it occurs all the time everyday. The question is, is it good medicine? All tests and procedures do have real risks of complications. Again 3% of future cancers are associated with radiologic scans. So for the less than 1% of the cases of fatigue with cancer as underlying diagnosis, we create an additional 3% of future cancers and increase the cost of healthcare in this country.

A comment on Isn't Tort Reform Only About Frivolous Cases?

Mike Bryant — Sun, 15 Nov 2009 18:54:58 GMT

So in the cases where they didn't do it right, you are saying yes there should be a case. But, at the same time you are saying that there are cases where doctors do too much, because real people come in with actual symptoms. And actually do have cancer a tumor. How exactly do you see a difference between the those cases??? Looks like there should have been defensive medicine in all of those examples.

A comment on Isn't Tort Reform Only About Frivolous Cases?

ian lin — Sun, 15 Nov 2009 16:28:06 GMT

I don't think even physicians would argue against fair and adequate compensation for wrong site surgery victims. I think caps do hurt these people.

But in regards to defensive medicine, these are not the cases that drive such practice. It's very obvious and clear cut in wrong site surgery cases. Either the doctor removed the wrong ovary or they didn't. If anything, this would prompt the surgeon/hospital to take more safeguards to help prevent such mistakes. That is good medicine.

The cases that drive defensive medicine are the subjective, gray zone ones. Delayed diagnosis of cancer and heart attacks are very common areas of litigation in primary care. But not everyone goes to their doctor with classic symptoms of these diseases. Some people can't even describe their symptoms, they just say, "Doc, I don't feel well, I can't describe it, but something is wrong. Fix me." I've seen people with heart attack have constipation as the main concern, without any other symptom. Most people with headaches do not have a brain tumor. But you won't have to do much convincing to get your doc to order you a MRI or CT "just to make sure." Most people with any trouble breathing won't have a clot in the lung. But the ER doc is almost guaranteed to order several thousand dollars worth of tests if you show up in the ER with that symptom. You say that the doctors are being thorough, and maybe that's good, even though there's a 3% risk of future cancer everytime you get a CT scan. But you can't say this is an inexpensive way to run healthcare.

A comment on Maui Mournes Loss Of "Na'i" Kana, "Tuku" Kana and Tyson Latham

Maikalani — Sat, 07 Nov 2009 22:42:33 GMT

im guna miss my cousins. Three beatiful souls and three amazing people to grow up with. You will never be forgotten and even though its been a month since you passed it feels like it was just yesterday when i was with you boys. I love you na'i, kalamaku & tys

A comment on Emily Midgley Dies in Big Island Hay Ride on Halloween

Wayne Parsons — Sat, 07 Nov 2009 02:08:49 GMT

Thanks for your comment.

A comment on Emily Midgley Dies in Big Island Hay Ride on Halloween

jason cornell — Thu, 05 Nov 2009 04:19:50 GMT

I have a friend who was riding in the same trailer, she was like an older sister to Emily. She says that Emily thought the ride was over and decided to jump off the trailer but didnt make it and fell under and was ran over by the trailer. I am very sorry for Emilys family but I know we all pray that little Emily is happy up in heaven. God bless her and her family and friends who all feel her loss.

A comment on Emily Midgley Dies in Big Island Hay Ride on Halloween

jason cornell — Thu, 05 Nov 2009 04:19:44 GMT

A comment on Recall of Chinese Drywall? Don't Hold Your Breath!

Gerry McGill — Tue, 27 Oct 2009 17:16:35 GMT

Wayne, as I understand it the experts have not reached a firm conclusion as to whether or not the drywall poses a significant health risk. However, the fumes are corrosive enough that they can cause the copper coils in air handler units to fail in as little as one year. I have one client who purchased a townhouse built in 2002 who has had to replace her interior air handler unit 6 times before discovering her home was built with Chinese drywall. Conventional wisdom is that the Chinese drywall problem started after the hurricanes of 2004 and 2005 but she unfortunately was a couple of years ahead of the times.