Friday, July 12, 2002 | 4:50 a.m.
THE JOY THAT swept over me after seeing two small lines on a home pregnancy test on Christmas Day 2000 dissipated for months until two small blue eyes finally looked up at me last summer.
Pregnancy in Las Vegas often begins with elation that quickly ebbs into a sea of uncertainty. My excitement drained into misery as test after often unnecessary test was ordered amid talk of the far-off possibility of doom and gloom for the baby.
It's all part of a nationwide $50 billion-a-year defensive medicine practice underlying the current medical malpractice crisis here.
In Nevada, women who can find an obstetrician aren't going to have comfy chats with Marcus Welby if my eight months of monitoring, testing, stopping labor, starting labor and eventual emergency C-section are any indication.
Even if the Legislature approves tort reform this month, nothing is going to quickly replace a current trend in patient care that favors managing a doctor's risk over the patient's comfort and sanity.
My son recently had a high fever requiring a check at UMC's pediatric emergency room. After the really high fever subsided, the doctor presented us with an unpleasant testing option -- tapping the baby's lumbar fluid to determine if the fever was caused by meningitis.
The doctor leaned in gently, as if to tell us what he, as a parent, would do in this case, and said: "When I conduct risk management seminars for our doctors, I tell them to do this test in this situation."
Even if what results is a defensive -- covering the physician's rear -- procedure, most patients don't question what the good doctor ordered.
Several major studies on defensive medicine -- including a landmark 1991 Harvard Medical School report -- suggest the practice is forever altering the field of medicine.
Defensive medicine is the constant audio notes you'll see doctors making on small recorders after routine visits -- tapes preserved to show how much care they gave you just in case you sue them down the road.
For pregnant women it's bloodwork, urine samples, genetic tests, and if you're lucky like me to have one small laser procedure in your past, weekly ultrasounds and exams that eventually give way to twice-a-week fetal monitoring.
All told: 23 ultrasounds, six trips to the lab to make sure I wasn't developing diabetes, more than 30 office checks, two hospital visits and the eventual rushed ambulance drive to the hospital after a fetal monitoring device moved off the baby's heartbeat and freaked out the nurses.
When the first six months of testing found nothing wrong, I mistakenly asked if all of it was necessary. The look I got suggested I didn't care about my baby's health.
The last days got even more defensive with drugs and injections to slow contractions, and eventually -- after being hospitalized to induce labor three weeks early -- an amniocentesis to check the baby's lungs. Then there were injections to speed contractions.
Any hopes for natural childbirth were gone the moment I entered the hospital.
When you're sitting in a hospital bed hooked to two machines and watching your baby's heart beat disappear from a monitor, you don't think about suing the doctor. You're just praying that you'll both make it OK.
Although mine wasn't what you'd call an at-risk pregnancy, I think the defensive medicine made for 37 weeks of anxiety and stress that probably put me into an at-risk category.
But when you're responsible not just for your own care, but for another life, you don't think anything a doctor requests is unnecessary.
That's why so many people think the $250,000 cap on pain-and-suffering lawsuits the doctors want is necessary. It's the fear of lawsuits, they say, that makes them practice defensively. The evil lawsuits are what's driving up their insurance, they add.
But what about the patient's insurance?
The fearful test-ordering, hyper-analyzing and over-prescribing makes it increasingly expensive for an insurance company to cover something that was once as routine as childbirth.
And those rates aren't going to be coming down anytime soon. Employer health care costs are expected to rise in double-digit fashion in each of the next two years.
It's workers who have co-payments and small business owners who are going to get pinched faster than the docs and their fear -- yes, at University Medical Center's trauma unit, it's fear only -- of lawsuits.
The trauma center's re-opening changes nothing. Capping damages might help after years -- make that decades -- of practice.
But for the immediate future, there's no cure for the way many patients are treated.
For starters doctors have to treat dozens of patients a day because of the pittance they get back from health maintenance organizations, Medicare and Medicaid.
In the old days, when doctors could study ways to improve beside manner instead of worrying about how they can pay the electric bill, there was more time for each patient. Patients knew their doctors a lot better and developed a trust that made it less likely they'd ever sue.
Now if only there was a way to legislate that.
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