This may be interested to some. I found this troubling. Recently I had a discussion with a local med mal JD. I was at a party of an old friend who is a newer lawyer (business law) but of course a lot of local JDs present. We started talking about policy stuff and I found he was a med mal guy so I asked some of his thought on med mal. We talked for a bit and while at many times I had visions of causing bodily harm to him, it did make me a bit concerned as there is a disconnect from what we are being told by our some of our medical brethren in journals/throwaways/podcasts/MD/JDs. I will paraphrase some of his comments. 1. Testing. I have been hearing often from my former groups lead MD/JD, people like Dr Henry, and such that increased testing never protected anybody. Phrases like "so you think not ordering/ordering a CT is going to be a deciding factor in if get sued?" I hear from them as they lecture us on resource utilization/medical costs/variation of practice of EM docs etc. I tell him this and his response: "That's Bull$&/)!” MrJD: when there is a bad case or outcome, and I see an upstream doc that had the chance to make the diagnosis with a test or procedure, I smile every time. I can get an expert from any specialty to debunk a doc's thought that his/her exam and thoughts are good enough these days. And if we go to trial, I have a pretty set script here. To the effect of "so Doctor, you just didn't care enough about my client to order this test?” Or “so my client was just a statistic, just a percentage to you?”…in reference to a retort I made on evidence based medicine and good clinical medicine. Jury's love that stuff! 2. Med mal will be getting worse for us (doctors). He is extremely knowledgeable of trends in healthcare, irritatingly so. He is extremely bullish on the med mal business in the coming years. MrJD: “You guys are being hung out to dry. So are hospitals. There is already starting to be a contraction on spending and costs (he used air quotes there). This is just awesome for me. There will be a lot of bad discharges, refused admits (what he seems to be calling us working up properly dispositioning patients that want admission from ED with follow up), procedure delays, diagnoses delays, all in the name of costs (air quotes again). Your societies and hospitals are masking this as evidence based practice, etc. But I can get a jury to see that very differently. A lot of physicians will be paying out before long, as will hospitals” He again referenced testing… "Testing is what makes diagnoses, saves people" I rebut and firmly discuss clinical acumen, experience, evidence and our own experts who could/would defend our actions "But that is in your world people live in mine… juries live in mine" - smug smile and chest tapping... I had to restrain myself I went back on the “refused admit” thing and he mentions to the effect of “If a patient is in the ER and wants to be admitted…you better just pray nothing happens in a reasonable time frame after if you discharge them against their wishes. I asked about defensive medicine protecting from us suits. Mr JD: “ to a point, it does. Will you get sued? Sure. Will I be less inclined to take a case that had a complete workup? Yup. If you appear to me like you cared and did everything you could, you certainly more protected. – I clarified, and to him/lay people, “everything we could and complete workup” basically equals Tests (labs/CTs/MRIs) in the ED. 3. Nurses will hang you. MrJD: “EHRs are awesome!” “And nurses chart everything they freaking think of while in the ER with a patient. They are there to cover their butt, and often it is very helpful to me. It is so common that there are discrepancies in the medical record, and now they are so easy to find.” 4. EHRs will hang you, see above. 5. Choosing Wisely: he thinks this will do nothing to protect anyone. He states any junior litigator can paint the doc and societies as the bad guy here. We know about nursing notes and EHRs of course. But the first two parts of our talk made me cringe. The "perception" is that tests must be done. But we are being told that there is no fear or little fear of addressing healthcare costs biting us. At best, the powers that be are simply not talking about it like they should be.