Defensive medicine is actually the medical mafia ensuring there are enough ill and diseased patients flowing through the doors to keep the system flush with profits. They are defending their incomes, benefits and profits, not your better long term health. Healthier patients over the long term are not conducive to the medical mafia's desire to make tons of money.
Succinct and to the point. Covid awakened much of the nation to the point that you make and it was largely responsible dropping the trust in the medical industry from 70%+ down to about 40%. Moreover it also supplied evidence that the vast majority of medical "professionals" willingly helped to reduce global populations through the application of a fraudulent vaccines. This was a direct result of the prescient remarks by Bill Gates in his original TED talk, that vaccines could easily be used to control global population levels in the future. Remarkably....those passages have since been scrubbed for all remaining videos of his speech. Modern medicine has fallen into the hands of some of the more baleful creatures on the globe.
COVID did a good job but it is amazing that 40% still trust the medical industry. All vaccines are fraud and 'medical professionals' are 'dismal fecal poisoners', an anagram of the phrase.
Ovarian Cancer Prevention: Moving From Paradigm Shift To A National Standard of Care ……. This came up this am in my daily medical podcast today . Damn if you do damn if you don’t …. People talk about revamping healthcare, the legal system is not much better . The patient saying no doesn’t always hold up in court…. Great topic today, thank you.
I would be willing to bet that the, cover your ass policy, is incorporated into more business models than just the medical industry.
It may not affect your health but it might affect your pocketbook ???
Coming from the automotive parts industry, think of the automobile safety checks the technicians have to do that lead to replacing “questionable parts” !!!
This is an excellent article addressing the phenomenon of over-testing. As a physician who practiced emergency medicine for 30 years, I can tell you there are significant factors of malfeasance. First, physicians know full well they are over-testing. They do not bother to learn the conservative approach and prefer willful ignorance. They do not want to spend the time having conversations with patients, and frequently these scans are ordered BEFORE any history or physical exam. That's not medicine, that's failure to discharge your duty as a physician. They often spend only a few seconds with the patient declaring, "great news - your scan doesn't show anything concerning". They are rewarded with higher revenue because ordering the scan increases the complexity of the case which means higher compensation. Under the new CMS documentation system, there is no longer a requirement for proper history and exam. The physician will import ".com" EMR medical decision making paragraphs into the chart that make it appear they "considered" multiple diagnoses that were "ruled out" with the scan. The patient hasn't a clue that they have just been the victim of a scheme; they walk away with a sense of relief that nothing was found, and that the physician was being thorough! Of course, many later realize they received no useful answer about their symptoms. This is bad medicine, laziness, and avarice. Frankly it is downright fraud. I spent countless hours trying to talk patients out of testing, begging consultants to just come and examine the patient before barking out requests for imaging studies to delay their arrival to the bedside. Until patients become actively engaged in their health, question the process, and demand accountability the fleecing will continue. Health literacy is woeful. What would be ideal is to have physician payment for legitimate time spent with patients. Even that paradigm would eventually be gamed, but it would at least introduce something patients can track -- time at the bedside. As a cost-saving measure, we may see denial of payment for these tests and then the doctors can point the finger at the insurance company. But this still doesn't change the duty to the patient.
Spot on with respect to over testing and defensive medicine.
Have to correct one gross error from the fraudulent claim in the JAMA article on CT scans causing huge amounts of cancer. This is fossil fuel industry anti-competitive propaganda, making people hysterical about radiation so they won't choose clean nuclear energy, over the fossil fuel pollution that kills 1:1000th of all humanity every year. The LNT "linear no threshold" model is pseudoscience or a secular religious belief, entombed in regulation. Every Cancer doc knows otherwise.
Under a scientific threshold model, the estimated number of radiogenic cancers caused by 93 million diagnostic CT scans is zero.
To compare the projections directly: The LNT guestimate yields a high estimate of approximately 103,000 cancers, whereas the well understood scientific threshold model yields a low estimate of exactly 0 cancers.
The divergence between the two models at these exposure levels is absolute. The typical effective dose for a medical CT scan ranges from roughly 2 mSv (head CT) to 15 mSv (abdomen/pelvis). The threshold model—supported by modern radiobiology and organizations like the Health Physics Society—places the threshold for observable radiation-induced stochastic or deterministic effects between 50 mSv and 100 mSv.
A standard CT scan is within the capacity of cellular DNA defense. A 10 mSv dose does not carry 1/10th the risk of a 100 mSv dose; it carries zero risk. The body's enzymatic repair and apoptotic pathways repair worse damage from thermal and chemical assaults every day.
The "conservative" label applied to the LNT model is an administrative misnomer when the model itself introduces massive secondary mortality risks in the real world. Skipping a useful CT is bad. Driving people to choose to murder 8 million people a year with avoidable fossil fuel pollution, instead of clean nuclear energy. These dual standards are clearly corrupt. Even if radiation pollution was worse than chemical pollution, in an honest world Coal still loses to Nuclear energy big time.
The JAMA paper's lie is reliance on the LNT based BEIR VII report. It derives its risk coefficients primarily from the Life Span Study of atomic bomb survivors in Hiroshima and Nagasaki—populations exposed to acute, high-dose radiation—and extrapolates those risks linearly down to the low-dose exposures typical of medical CT scans (generally between 1 and 30 mSv). So if a nuclear bomb is dangerous, a fire cracker a mile away must be dangerous too, proportionally speaking. NOT!
A self sustaining income stream... at the risk of iatrogenic harm to the patient. I have seen it happen, have had it happen to me, and am grateful that you have articulated and presented the problem so clearly.
What is astounding is that so many folks do not see it.
I am not defending health care. There are many problems, but we allow ourselves to be easily manipulated and allow fear to control our healthcare decisions. Anytime something unfortunate happens, there is dateline with a “special” about how negligent healthcare can be and how to protect yourself. Now it’s even worse with social media. I am a nurse and people are angry if you don’t do enough and they are angry if you do too much. It’s frustrating at all angles. I’m not surprised many of these problems exist. There are also a surprising number of people who do not want anything different because they do not want to change their lifestyles. They want an easy fix. I work with great people who try really hard to spare people unnecessary prescriptions and procedures. So, yes there is corruption and greed. But there are also problems on the other side of it as well.
Excellent summary of what’s happening to many in our own lives (we’ll be sharing), many who no longer are (parents who were over treated by “through and caring” geriatricians and specialists and likely died from testing, surgeries, and medications), and many on our own Substack who need to know all of this before their next clinic visit.
As a physician you get surprised relatively frequently. Being defensive, can you blame us look at those boys did to Palestine. Can you imagine the bloodthirsty attorneys looking for easy money putting me in the poor house. Changing the laws is the only answer.
Excellent article. In US the question becomes how much of the 5 Trillion spent annually is created by lawsuits? Many of which are settled for the plaintiff when risks of adverse effects were known and Explained to the patient. A portion of are justifiable.
We also think of the thousands killed or injured by liability-protected medical interventions (e.g., vaccines of all types but especially COVID shots along with continuing deadly COVID hospital protocols). PREP Act and National Childhood Vaccine Injury Act of 1986 remove liability from anyone administering these interventions, which is the opposite case discussed in Unbekoming’s excellent piece.
These patients and their families are unable to sue successfully in standard courts or so-called “vaccine courts.” Instead, they are left with a lifetime of suffering from medical “treatments” or denials of treatment, as well as medical and legal bills.
As a GP, I often have to explain to my Pts that nothing in medicine is 100% sensitive and 100% specific, so tests need to be interpreted in context of the clinical picture employing clinical judgement and Pt's preferences.
In the UK there is a perception that GPs/doctors and the NHS are generally negligent and indifferent. So, when I offer tests and share the downsides of said tests these are rarely (if ever) declined.
Doctors aren't completely to blame here, people in general rarely think long term and seem to be living with varying degrees of health anxiety and jump at any test (or jab) that is offered to them. They also rarely appreciate or heed the advice of doctors who, out of a genuine concern of their wellbeing, will share the inconvenient truths about any treatment or investigation.
I recently received my first ever complaint from a young male Pt to whom I dared to discuss the downsides of SSRIs. So it's not just the wider landscape which results in defensive medicine, but individual peoples and pts behaviour that perpetuates it.
Many thanks, a sad but true reflection of the medical industrial complex. Other industries are similar but I can't think of those where harm is so significant.
I see 'defensive medicine' anagrams to:
- deceived feminines
- misdefine evidence
- Eve indemnified sec
- feed indecisive men
indemnified and indemnifies are two of the three longest single words. I find this remarkable.
P.S. You mention MRI briefly. This may be as harmful as CT scans, especially the use of gadolinium in contrast dyes. This may be the cause of my thyroid issues in 2020 and the very strong magnets may well upset one's internal electrical system.
Defensive medicine is actually the medical mafia ensuring there are enough ill and diseased patients flowing through the doors to keep the system flush with profits. They are defending their incomes, benefits and profits, not your better long term health. Healthier patients over the long term are not conducive to the medical mafia's desire to make tons of money.
Succinct and to the point. Covid awakened much of the nation to the point that you make and it was largely responsible dropping the trust in the medical industry from 70%+ down to about 40%. Moreover it also supplied evidence that the vast majority of medical "professionals" willingly helped to reduce global populations through the application of a fraudulent vaccines. This was a direct result of the prescient remarks by Bill Gates in his original TED talk, that vaccines could easily be used to control global population levels in the future. Remarkably....those passages have since been scrubbed for all remaining videos of his speech. Modern medicine has fallen into the hands of some of the more baleful creatures on the globe.
COVID did a good job but it is amazing that 40% still trust the medical industry. All vaccines are fraud and 'medical professionals' are 'dismal fecal poisoners', an anagram of the phrase.
https://baldmichael.substack.com/p/medical-profession-whats-in-the-phrase?utm_source=publication-search
Ovarian Cancer Prevention: Moving From Paradigm Shift To A National Standard of Care ……. This came up this am in my daily medical podcast today . Damn if you do damn if you don’t …. People talk about revamping healthcare, the legal system is not much better . The patient saying no doesn’t always hold up in court…. Great topic today, thank you.
I would be willing to bet that the, cover your ass policy, is incorporated into more business models than just the medical industry.
It may not affect your health but it might affect your pocketbook ???
Coming from the automotive parts industry, think of the automobile safety checks the technicians have to do that lead to replacing “questionable parts” !!!
This is an excellent article addressing the phenomenon of over-testing. As a physician who practiced emergency medicine for 30 years, I can tell you there are significant factors of malfeasance. First, physicians know full well they are over-testing. They do not bother to learn the conservative approach and prefer willful ignorance. They do not want to spend the time having conversations with patients, and frequently these scans are ordered BEFORE any history or physical exam. That's not medicine, that's failure to discharge your duty as a physician. They often spend only a few seconds with the patient declaring, "great news - your scan doesn't show anything concerning". They are rewarded with higher revenue because ordering the scan increases the complexity of the case which means higher compensation. Under the new CMS documentation system, there is no longer a requirement for proper history and exam. The physician will import ".com" EMR medical decision making paragraphs into the chart that make it appear they "considered" multiple diagnoses that were "ruled out" with the scan. The patient hasn't a clue that they have just been the victim of a scheme; they walk away with a sense of relief that nothing was found, and that the physician was being thorough! Of course, many later realize they received no useful answer about their symptoms. This is bad medicine, laziness, and avarice. Frankly it is downright fraud. I spent countless hours trying to talk patients out of testing, begging consultants to just come and examine the patient before barking out requests for imaging studies to delay their arrival to the bedside. Until patients become actively engaged in their health, question the process, and demand accountability the fleecing will continue. Health literacy is woeful. What would be ideal is to have physician payment for legitimate time spent with patients. Even that paradigm would eventually be gamed, but it would at least introduce something patients can track -- time at the bedside. As a cost-saving measure, we may see denial of payment for these tests and then the doctors can point the finger at the insurance company. But this still doesn't change the duty to the patient.
Spot on with respect to over testing and defensive medicine.
Have to correct one gross error from the fraudulent claim in the JAMA article on CT scans causing huge amounts of cancer. This is fossil fuel industry anti-competitive propaganda, making people hysterical about radiation so they won't choose clean nuclear energy, over the fossil fuel pollution that kills 1:1000th of all humanity every year. The LNT "linear no threshold" model is pseudoscience or a secular religious belief, entombed in regulation. Every Cancer doc knows otherwise.
Under a scientific threshold model, the estimated number of radiogenic cancers caused by 93 million diagnostic CT scans is zero.
To compare the projections directly: The LNT guestimate yields a high estimate of approximately 103,000 cancers, whereas the well understood scientific threshold model yields a low estimate of exactly 0 cancers.
The divergence between the two models at these exposure levels is absolute. The typical effective dose for a medical CT scan ranges from roughly 2 mSv (head CT) to 15 mSv (abdomen/pelvis). The threshold model—supported by modern radiobiology and organizations like the Health Physics Society—places the threshold for observable radiation-induced stochastic or deterministic effects between 50 mSv and 100 mSv.
A standard CT scan is within the capacity of cellular DNA defense. A 10 mSv dose does not carry 1/10th the risk of a 100 mSv dose; it carries zero risk. The body's enzymatic repair and apoptotic pathways repair worse damage from thermal and chemical assaults every day.
The "conservative" label applied to the LNT model is an administrative misnomer when the model itself introduces massive secondary mortality risks in the real world. Skipping a useful CT is bad. Driving people to choose to murder 8 million people a year with avoidable fossil fuel pollution, instead of clean nuclear energy. These dual standards are clearly corrupt. Even if radiation pollution was worse than chemical pollution, in an honest world Coal still loses to Nuclear energy big time.
The JAMA paper's lie is reliance on the LNT based BEIR VII report. It derives its risk coefficients primarily from the Life Span Study of atomic bomb survivors in Hiroshima and Nagasaki—populations exposed to acute, high-dose radiation—and extrapolates those risks linearly down to the low-dose exposures typical of medical CT scans (generally between 1 and 30 mSv). So if a nuclear bomb is dangerous, a fire cracker a mile away must be dangerous too, proportionally speaking. NOT!
A self sustaining income stream... at the risk of iatrogenic harm to the patient. I have seen it happen, have had it happen to me, and am grateful that you have articulated and presented the problem so clearly.
What is astounding is that so many folks do not see it.
I am not defending health care. There are many problems, but we allow ourselves to be easily manipulated and allow fear to control our healthcare decisions. Anytime something unfortunate happens, there is dateline with a “special” about how negligent healthcare can be and how to protect yourself. Now it’s even worse with social media. I am a nurse and people are angry if you don’t do enough and they are angry if you do too much. It’s frustrating at all angles. I’m not surprised many of these problems exist. There are also a surprising number of people who do not want anything different because they do not want to change their lifestyles. They want an easy fix. I work with great people who try really hard to spare people unnecessary prescriptions and procedures. So, yes there is corruption and greed. But there are also problems on the other side of it as well.
Excellent summary of what’s happening to many in our own lives (we’ll be sharing), many who no longer are (parents who were over treated by “through and caring” geriatricians and specialists and likely died from testing, surgeries, and medications), and many on our own Substack who need to know all of this before their next clinic visit.
As a physician you get surprised relatively frequently. Being defensive, can you blame us look at those boys did to Palestine. Can you imagine the bloodthirsty attorneys looking for easy money putting me in the poor house. Changing the laws is the only answer.
Thank you!!!
Excellent article. In US the question becomes how much of the 5 Trillion spent annually is created by lawsuits? Many of which are settled for the plaintiff when risks of adverse effects were known and Explained to the patient. A portion of are justifiable.
We also think of the thousands killed or injured by liability-protected medical interventions (e.g., vaccines of all types but especially COVID shots along with continuing deadly COVID hospital protocols). PREP Act and National Childhood Vaccine Injury Act of 1986 remove liability from anyone administering these interventions, which is the opposite case discussed in Unbekoming’s excellent piece.
These patients and their families are unable to sue successfully in standard courts or so-called “vaccine courts.” Instead, they are left with a lifetime of suffering from medical “treatments” or denials of treatment, as well as medical and legal bills.
As a GP, I often have to explain to my Pts that nothing in medicine is 100% sensitive and 100% specific, so tests need to be interpreted in context of the clinical picture employing clinical judgement and Pt's preferences.
In the UK there is a perception that GPs/doctors and the NHS are generally negligent and indifferent. So, when I offer tests and share the downsides of said tests these are rarely (if ever) declined.
Doctors aren't completely to blame here, people in general rarely think long term and seem to be living with varying degrees of health anxiety and jump at any test (or jab) that is offered to them. They also rarely appreciate or heed the advice of doctors who, out of a genuine concern of their wellbeing, will share the inconvenient truths about any treatment or investigation.
I recently received my first ever complaint from a young male Pt to whom I dared to discuss the downsides of SSRIs. So it's not just the wider landscape which results in defensive medicine, but individual peoples and pts behaviour that perpetuates it.
Many thanks, a sad but true reflection of the medical industrial complex. Other industries are similar but I can't think of those where harm is so significant.
I see 'defensive medicine' anagrams to:
- deceived feminines
- misdefine evidence
- Eve indemnified sec
- feed indecisive men
indemnified and indemnifies are two of the three longest single words. I find this remarkable.
P.S. You mention MRI briefly. This may be as harmful as CT scans, especially the use of gadolinium in contrast dyes. This may be the cause of my thyroid issues in 2020 and the very strong magnets may well upset one's internal electrical system.
"The first is what happens if we wait? Most diagnostic decisions are not emergent. "
Did you mean "Most diagnostic decisions are not an emergency"?
You are incredibly prolific, and keep it going!