Study: Doctors order tests out of fear of lawsuits (AP)

By MARILYNN MARCHIONE, AP Medical Writer Marilynn Marchione, Ap Medical Writer – Wed Feb 16, 6:56 pm ET

SAN DIEGO – CT scans, MRIs and other pricey imaging tests are often more for the doctor's benefit than the patient's, new research confirms.

Roughly one-fifth of tests that bone and joint specialists order are because a doctor fears being sued, not because the patient needs them, a first-of-its-kind study in Pennsylvania suggests.

The study comes a day after President Barack Obama began a push to overhaul state medical malpractice laws as a way to reduce unnecessary tests that drive up health care costs.

"This study is a glimpse behind the curtain of what's happening in a doctor's mind," said its leader, Dr. John Flynn of Children's Hospital of Philadelphia. If doctors sense you might second-guess them or cause trouble, "you could potentially be risking more tests being done."

Results were reported Wednesday at an American Academy of Orthopedic Surgeons conference in California.

Patients expect the highest level of care and think this means the most advanced technology, Flynn said. Many patients feel better when a doctor orders lots of tests — until they get the bill.

Besides hurting your wallet and adding to health care costs, unnecessary tests can expose people to radiation that accumulates over a lifetime and can raise the risk of cancer. Ordinary X-rays are rarely a concern, but an MRI, or magnetic resonance imaging scan, can cost $1,000 or more. And super-sharp X-rays called CT scans involve relatively large radiation doses.

Yet doctors often order tests they don't really think a patient needs because they fear being sued if the diagnosis was wrong or they miss detecting a problem.

Previous studies of how often this happens have relied on doctor surveys. This is the first one to enlist doctors in advance to track their decisions over time.

It involved 72 orthopedic surgeons throughout Pennsylvania who tracked tests they ordered on 2,068 patients, mostly adults, in ordinary office visits, emergency rooms and other settings. Doctors checked a box saying a test was either required for clinical care or done "for defensive reasons."

Defensive imaging accounted for 20 percent of total tests — 11 percent of X-rays, 38 percent of MRIs, 33 percent of CT scans, 57 percent of bone scans and 53 percent of ultrasounds.

Defensive medicine also accounted for 35 percent of costs, nearly all of it from MRIs.

One example: a torn meniscus, a knee cartilage injury that is a leading reason for knee surgery. Studies have shown that a doctor's judgment based on symptoms and an exam is even better than an MRI to diagnose the condition. Yet patients hardly ever go to surgery without having the imaging test, Flynn said.

Surprisingly, the study found that newer doctors were less likely to be defensive.

"That's counterintuitive," Flynn said. "You would expect when you're new in practice, not as trustful of your clinical judgment, you'd order more."

Doctors who have been sued in the last five years were more likely to order tests defensively, said Robert Miller, a Temple University medical student who helped lead the study and presented the results at the conference. The authors said similar studies are needed on defensive imaging in other specialties.

Dr. Lawrence Wells, a Philadelphia surgeon who participated in the study, said doctors learn to develop "a radar" for problem patients.

"It's disheartening" to be sued, he said. "Someone's accusing you of a bad outcome or a wrong," and that can affect how a doctor behaves the next time he sees a similar case.

Patients need to trust their doctor's judgment on what is needed, Wells said.

On Tuesday, Obama made a budget proposal that includes money to help states rewrite malpractice laws. Possible measures include caps on awards. The administration also has proposed health courts where specially trained judges rather than juries would decide such cases.

Questions to ask about a medical test:

_Is it truly needed? How will it change my care?

_Have you or another doctor done this test on me before?

_Does the test involve much radiation and is there an alternative that does not?

_How many images are needed?

_Do you have a financial stake in the machines that will be used?

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Online:

Orthopedics group: http://www.aaos.org/

Consumer information: http://www.radiologyinfo.org and http://tinyurl.com/2wv5fg

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Judge order trial for man in Mich. mosque plot (AP)

DEARBORN, Mich. – A California man accused of plotting to attack a popular Detroit-area mosque was ordered to stand trial Friday after police testified that he had 96 fireworks in his car, including M-80 firecrackers and smoke bombs.

Roger Stockham was arrested Jan. 24 during a traffic stop near the Islamic Center of America in Dearborn. Witnesses said the 63-year-old Vietnam War veteran spoke hours earlier at a bar about setting off an explosion at the mosque.

Dearborn Officer John Kostiuk said the fireworks were found in a paper bag on the front passenger seat of Stockham's Chrysler PT Cruiser. Officer Stanley Chiles, a bomb technician, testified that Stockham's cache included fireworks that are illegal in Michigan and potentially dangerous.

Chiles said the fireworks could have hurt someone, especially if combined with the alcohol and spray paint that officers found in the car and gasoline in the tank.

Judge Mark Somers found probable cause to order a trial on charges of making a false report or threat of terrorism and possessing explosives with an unlawful intent.

His next court date is Feb. 18 in Wayne County Circuit Court in Detroit.

Stockham of Imperial Beach, Calif., has a history of mental illness. He has been caught during the past three decades for a string of felonies — from kidnapping his son and attempting to hijack a plane to planting a bomb outside an airport — and spent time in various prisons and mental health hospitals.

Outside court, defense attorney Matthew Evans said it was "kind of a stretch" to label the fireworks as powerful — particularly in connection with the gas in the tank and spray paint. He said authorities have exaggerated the threat posed by Stockham and argued that police "don't even have matches" in evidence.

"It just didn't make any sense," he said. "Once you got the guy in custody, all he's got is a bunch of firecrackers he can buy 40 miles south of here."

The judge said it would not be necessary to have the fireworks in the courtroom and denied Evans' request to have police bring them in.

Evans said Stockham was interested in social protest, not attacking the mosque, and intended to spray paint the words "Crazy Horse 18" on or around the building. The phrase refers to a U.S. Apache helicopter involved in a 2007 attack in Iraq that killed a Reuters news photographer and his driver. Classified video of the attack was posted online last year.

Evans said Stockham's anger was directed at the helicopter's pilot and the U.S. government for not doing more to investigate the attack.

"He wanted to bring attention to it — he wanted to do it in a public way," Evans said. "He wanted media attention — no doubt about it. He just got a little more than he expected."

Dearborn, a Detroit suburb, is the hub of the region's Arab-American community, one of the largest in the U.S. A third of the city's 100,000 residents trace their roots to the Arab world.

Joe Nahhas, a manager at a Detroit restaurant, testified Friday that he called 911 and the FBI after spending time talking to Stockham in his eatery. He said Stockham told him he was typing letters intended for the media on a laptop computer and wanted Nahhas to distribute them after a "big explosion."

"I asked him where — where's the explosion?" Nahhas said. "He said 'Here, there, the mosque.'"

Nahhas said Stockham spoke of his conversion to Islam after serving in the Vietnam War and learned about the religion from Indonesian mujahedeen, or holy warriors. He called himself a mujahedeen, which Nahhas said "raised a flag immediately" for him.

"I know what the word mujahedeen means," Nahhas said. "I can read, write and speak Arabic."

In 2002, Stockham was accused of making threats against President George W. Bush and officials at Vermont facilities for veterans.

He was released three years later from a medical center in Springfield, Mo., which treats federal inmates with mental-health problems. Stockham was ordered to abstain from alcohol and continue psychiatric treatment.

He has been caught during the past three decades for a string of felonies — from kidnapping his son and attempting to hijack a plane to planting a bomb outside an airport — and spent time in various prisons and mental health hospitals.

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