0:00

hey season 2, here we come back

0:03

on hulu we're back in

0:05

case you missed

0:06

us, we

0:07

are starting to talk

0:10

wedding dresses everything

0:11

gets elevated,

0:14

i believe in love with you love

0:16

you know you're alive you have the feelings, no

0:19

matter how crazy things are we're

0:22

always going to be family

0:24

the

0:25

kardashians season two stream

0:27

this september only on hulu

0:35

the supreme court rendered it's decision

0:37

and dobbs vs jackson women's health

0:39

in june of this year not long

0:41

afterward doctor louise king started

0:44

hearing how it was affecting women's

0:46

health care we hear these

0:47

cortez delays and care for

0:50

topics or miscarriages and trying to

0:52

reach some particular

0:54

moment in time where it's life threatening

0:56

so that you can intervene

0:58

it is not how we practice medicine we intervene

1:01

way way ahead of time

1:02

for something up to that point the

1:04

dogs decision overturn roe versus

1:07

wade in nearly fifty years of

1:09

legal precedent guaranteeing the

1:11

constitutional rights to have an abortion

1:13

in the u s in some states

1:15

abortion immediately became illegal

1:18

or nearly illegal it also cause

1:20

confusion about what doctors were allowed

1:22

doctors do

1:23

anybody who is in one of those states

1:25

has carefully trying to negotiate the laws

1:28

and stay within them as much as they possibly

1:30

can even though that compromises their delivery

1:32

as standard care

1:34

the weed is an obstetrician gynecologist

1:36

at brigham and women's hospital in boston but

1:39

she's also lawyer they didn't

1:41

care is a legal term and a medical one

1:44

it usually refers to a diagnostic a

1:46

treatment process the declination

1:48

should follow for a certain type of patients illness

1:51

or clinical circumstance sometimes

1:53

though as louis describe physicians

1:55

ability to deliver the standard of care that

1:58

compromised by the law the legal

2:00

system so what happens then

2:04

the for economics radio network this

2:06

is for economics md i'm bob

2:08

agenda they on the show the

2:11

dobbs decision is new but

2:13

health care providers worrying about the legal

2:15

consequences of their actions is

2:17

not

2:18

i think it's fair to say pretty weldon

2:20

into

2:20

the fabric of medical practice for

2:22

physicians to seek to protect themselves

2:25

will talk with lawyer and how policy experts

2:27

michelle mellow about what happened when

2:29

physicians seek to protect themselves

2:32

whether they're providing reproductive care or

2:34

any other servers and ,

2:36

doctor lewis king and i will talk about the big

2:39

questions facing her field in

2:41

light of the daughter says says

2:43

gyn has always been at the center as

2:45

aspects mainly because of the focus

2:47

on abortion and how

2:50

we provide that

3:10

the with a couple of things that you're

3:11

interests one was just personal i was

3:13

friends with a lot of med students and interested

3:15

in the process of socialization

3:17

as they became physicians so

3:19

it became clear to me pretty early

3:21

on

3:22

the liability was something

3:24

that was on their minds even as trainees

3:26

and that it was affecting the way

3:28

they thought

3:29

that he said michelle mellow

3:31

was friends with future doctors but she

3:33

didn't want to be one instead she

3:35

became a lawyer who thinks a lot about doctors

3:38

and what they do now is a

3:40

professor at stanford law school and stanford

3:42

medical school the he tries to understand

3:44

the effects of law and regulation on

3:46

healthcare particularly in the

3:48

areas of liability and medical malpractice

3:51

concerns about being sued for malpractice

3:54

for negligence can cause doctors

3:56

to change the way they do their work attains

3:59

it's referred to as

3:59

defensive medicine

4:01

this change has cause for patients and

4:04

for the healthcare system when you ten

4:06

michelle and a few coauthors estimated

4:08

that the bill for defensive medicine was

4:11

around forty six billion dollars annually

4:16

we generally defined defensive medicine

4:19

eyes engaging in clinical

4:21

behave years primarily

4:24

has he was like

4:25

reduce the risk of a lawsuit

4:28

and not primarily out

4:30

of clinical judgment

4:32

the let me build on that a little further if a doctor

4:35

there's something orders a test

4:37

let's say because they're worried about the threat

4:39

of liability but that test is

4:41

actually appropriate and helps the patient

4:44

you and called that defensive medicine would you i

4:47

would because my

4:48

finishing jumps off the physicians

4:50

intention was the real

4:52

then why the testers order was in your hypothetical

4:54

here it's ordered because the physician

4:56

would like to reduce slide the now many

4:59

the things that physicians do because

5:01

they would like to reduce their liability in fact

5:03

may end up helping the in releasing neutral

5:06

with respect to the patience welfare we

5:08

don't serve subtracted from the entered

5:10

medicine because

5:11

that happens to prove to them the right call

5:14

i may kind of separate those two because

5:16

one sort of behavior in

5:19

an economic sense wasteful so of doctors

5:21

are worried about the threat a liability the

5:23

order extra laboratory

5:25

tests extra imaging that's not

5:27

clinically useful or appropriates that

5:29

just generates waste for the system but doesn't generate

5:32

any benefits that really feels like

5:34

wasteful defensive medicine whereas

5:36

the other sort of medicine that you described were the

5:39

intent of the doctor might be the same to

5:41

reduce their risk of being sued but

5:44

they're actually doing something that's helpful for the patient

5:47

that used to me like the intent of the

5:49

malpractice system

5:50

i think the way legal scholars tend to think

5:52

about it is that see and ten of the malpractices

5:55

some is to deter

5:56

negligence it's to discourage

5:59

physicians from practicing below

6:01

the legal standard of care so there

6:03

are lots of things that we want doctors to do for patients

6:06

because we know that for patients

6:08

in that same or similar situation it

6:10

ends up being useful to them and not

6:13

waste of if a position does

6:15

those things probably due to the idea

6:17

forces right maybe they're concerned about

6:19

lie billie but also they know this is usually the right

6:21

thing to do the patient like this and also maybe

6:23

they know they'll get more payment if they do the things

6:26

that deterrent that serve bringing physicists

6:29

to where we want them to these defensive

6:31

medicine is that neither region

6:33

above the deterrents cut off his

6:35

where physicians are now doing things

6:38

for reasons that are more divorced

6:40

from their clinical judgment and that are

6:42

more likely to result either and waste

6:45

or actually because some of these behaviors

6:47

are not doing more stuff they're doing lasts

6:50

could result in harm to patients who

6:52

are not able they get they care they need

6:55

the term to refer to those two types of behaviors

6:57

one were you doing more when we didn't last

6:59

we call they're doing more stuff

7:01

assurance behavior

7:02

then we call it doing less das avoid

7:04

as behaviors

7:05

how com i would you say these two types of behaviors

7:08

are

7:09

they're really common when we do

7:11

survey says issue we see very

7:13

very high levels of people saying

7:15

yes i do these assurance behaviors are

7:17

stance yes i do these avoids

7:19

behaviors often

7:22

one survey michelle and some coauthors

7:25

did said a lot of light on just

7:27

how often physicians engage

7:29

in assurance and avoidance behaviors

7:32

two dozen three they surveyed eight

7:34

hundred and twenty four physicians in pennsylvania

7:37

across six specially it was

7:39

was environment for malpractice insurance

7:41

especially in pennsylvania the

7:43

cost of liability insurance in the states

7:46

had shut up mostly due to the

7:48

high price of investigating the sending

7:50

and paying legal claims in the states

7:53

at the time as a result

7:55

physicians hospitals and medical groups

7:57

were struggling to find and retain com

8:00

to take care the worst case scenario when we

8:03

serve it physicians in pennsylvania

8:05

back two thousand three at the height of what

8:08

people call that a malpractice insurance crisis

8:11

ninety three percent of them said

8:13

that they practice defensive medicine

8:16

sometimes or often and

8:18

forty two percent of them said that they

8:20

do these avoidance behavior switch on

8:22

the cutting back on irish procedures

8:25

which is into see groups of patients that they

8:27

perceive to be higher risk suing

8:29

them those things that can really lead

8:31

to pay since having difficulty accessing

8:33

the care that they need

8:39

when you say assurance behavior

8:41

can give me an example of the type of saying

8:43

that a doctor might do to avoid the bible

8:46

us

8:47

the parody matic example is probably ordering

8:49

expensive scans like a city scanner

8:52

and m r i when the doctors really think

8:54

is indicated but there are other

8:56

forums as well physicians

8:58

could prescribe more medications and

9:00

they think are medically necessary especially

9:02

if the patients asking for particular medicine

9:05

for example antibiotics for antibiotics infection

9:07

that the physician thanks doesn't require it's

9:09

day suggests invasive procedures

9:12

like biopsies to confirm diagnoses

9:14

that they already feel pretty confident about

9:17

and then again on the avoidance behavior find it's mostly

9:19

cutting back on high risk procedures

9:22

like delivering women higher risk

9:24

for adverse pregnancy our com or

9:26

avoiding caring for certain has a high risk

9:28

patients i've had physicians in this pennsylvania

9:30

survey for example tommy santa like

9:32

secure a lawyers

9:34

interesting by ,

9:36

way i have tried to look at whether not in

9:38

large scale data where the doctors

9:41

treat lawyers any differently haven't found any evidence

9:43

of that yet but not to say that it doesn't occur

9:46

they are just another wrinkle as and in addition to

9:48

avoiding high risk patients who might be more

9:50

likely to require highest procedures there

9:52

is evidence that physicians will curtail

9:54

just doing

9:55

the whole categories of procedures that push

9:57

them up into a higher bracket of

9:59

my billie

9:59

like firemen ob gyn

10:02

maybe now i'm just gonna do to

10:06

a paper that you describe

10:08

that was based on the survey of doctors in

10:10

pennsylvania me basically sound that everybody

10:13

are almost everybody engagingly

10:15

, form of defensive medicine medicine

10:18

to me that almost suggest that defensive medicine

10:20

is like in a sense it's medicine itself it's

10:22

so deeply ingrained that

10:25

these doctors didn't know how to practice medicine without

10:27

to

10:28

well again that surveys conducted

10:30

in

10:30

the high risk say at a high risk time

10:33

so the hopefully in peacetime

10:35

it's a little bit less com and that

10:37

was in this service that

10:39

so you know i think it's fair to say

10:41

pretty woven into

10:42

the fabric of medical practice for

10:44

physicians to seek to protect themselves

10:46

and that's not surprising are

10:49

there any feel that are more likely to exhibit

10:51

these behaviors where the malpractice library

10:53

risk is particularly high or your

10:56

senses that defensive medicine is just much

10:58

more common yeah there are variations

11:01

in the risk of sit across specialty

11:02

than a specialties that tend to have the highest

11:05

risk our emergency medicine

11:07

physicians

11:08

various kinds of surgeons especially

11:10

orthopedic and neurosurgeons an

11:13

obstetrician gynecologist so

11:15

that may be a good segue to the issue of the supreme

11:17

court decision recently with respect

11:20

to roe v wade what would

11:22

be your prediction then with the da

11:24

decision for obese who are thinking about

11:26

whether or not the continue practicing abortion what's

11:29

your early take on this issue

11:31

the natural extension of physicians

11:34

concerned about defensive medicine would be that

11:36

we would expect them to almost

11:38

be over complying with

11:40

restrictive abortion laws if

11:42

they seal uncertain about their vulnerabilities

11:45

to depending on the state criminal prosecution

11:48

or civil suit that's

11:51

what defensive medicine arises from it arises

11:53

from and certainty i don't know what

11:55

i was be doing here to meet the legal

11:57

standard of care and

11:59

so

11:59

gonna do everything possible to protect

12:02

myself what may see

12:04

abortion case difference case difference

12:06

from at least the

12:07

assurance behaviors that we've been talking about

12:09

like doing more tests are giving more referrals

12:12

is that's no longer

12:14

ten a physician maintain an inner monologue

12:16

that says well this won't hurt my patient

12:19

and might have that's patently

12:21

untrue when it comes to reproductive

12:23

healthcare so it tends

12:25

to resemble more of physicians

12:27

decision say gauge in these avoidance

12:30

behaviors it's you

12:32

know why those decisions on steroids because

12:34

this is not sort of ah deliberate

12:36

decision i am one a stopped delivering babies

12:38

or i don't want to

12:39

the when with high risk pregnancies anymore

12:42

this is a response

12:43

the patient who is right in front of the

12:45

physician in the moments asking

12:47

for and requiring medical intervention

12:50

though imagine a provider is in the

12:52

state where abortion is now banned

12:55

in some form and ,

12:57

seeing a patient who has

12:59

maybe the scenic topic pregnancy and

13:02

there's a risk of harm to

13:04

the mom how does the provider

13:06

than think about these different legal

13:09

risk as on one hand there's the

13:11

risks associated with providing

13:13

an abortion that's illegal restated new

13:16

now and on the other hand there's

13:18

hand risk of not performing standard

13:20

of care for the mom

13:22

how would a provider negotiator bounce those

13:24

two legal issues

13:27

the think it's really really hard right

13:29

now and i would not expect any

13:31

provider to feel comfortable navigating that situation

13:33

without advice from legal counsel which

13:35

hospitals around the country are now busily trying

13:37

to put together but you're absolutely

13:40

right that there are conflicting legal obligation

13:42

here and the upshot is that is even

13:45

if you wanted to practice defensively in that situation

13:48

it's not clear what the right decision is so

13:50

on the one hand you've got this here

13:52

as possible prosecution or civil

13:54

suit under restrictive state abortion laws

13:57

on the other he could be medical mal this

13:59

not

13:59

three the pace

14:00

in a situation probably as an

14:03

additionally if this is a patient seen

14:05

in an emerging care setting and

14:08

the patient is not stable and

14:10

that treatment that's required to stabilize

14:12

the patient's condition is the abortion services

14:14

that's a violation

14:16

the federal law

14:17

do you think them as gray area might

14:20

be purposeful in some sense images

14:22

a tremendous amount of chaos as being

14:24

generated docs ,

14:26

are scared of performing abortions and

14:28

medically indicated circumstances

14:31

indicated sort of this chilling effect what are the

14:33

byproducts of this ruling

14:36

the main by parker

14:37

that it leaves it up to state legislature

14:39

to adopts more less than a law

14:42

that they would like restricting abortion

14:44

and you may be right that some of

14:47

those legislators have chosen to be deliberately

14:49

vague inserting ,

14:51

in most cases providing acceptance

14:53

to save the lives of the mother for

14:56

example or to prevent serious

14:58

health harm to the mother but not

15:00

defining what those are says

15:03

year someone who would like to have this you

15:05

abortions as possible dance

15:07

that kind of strategic ambiguity in the it

15:10

could produce exactly the kind of result

15:12

that you want

15:15

the same time when a law is deliberately

15:18

vague like that there is latitude more

15:21

reasonable practitioners on the ground to come

15:23

in and interpret it the way that they want

15:26

we're does all the sleep patience and

15:28

what ethical challenges will abortion

15:30

care providers face as they enter

15:32

this new era they might from nutley

15:34

lose their licence they probably have a family

15:36

to care for dot , livelihood

15:39

that's a lot ask as an individual person

15:42

i'm bob agenda and freakonomics

15:44

md

15:52

sometimes you need to take control to

15:54

make difference why i with flex pass

15:56

from university, you're in control, set

15:59

your own deadline

15:59

and leverage your experience to move at a pace

16:02

that works for you discover a different

16:04

way forward a capella dot edu

16:12

i think you're probably the first bioethicist

16:14

or talk to on the show so maybe you could tell me what

16:16

is a bioethicist do one thing that we

16:18

really don't do is truly answer quest

16:21

isn't perfect just like economists

16:23

ssssss you

16:25

hear doctor louise king did

16:27

answer my questions during our interview though

16:29

and her feel right now that's not so easy to

16:31

do she's a gynecologic surgeon

16:34

and a bioethicist at harvard medical school

16:36

a combination that sometimes also

16:38

requires her to think like a lawyer hurl

16:41

job in it especially true

16:43

since the supreme court handed out it's

16:45

decision and dobbs vs jackson

16:47

women's health so far at least

16:49

thirteen states have banned most abortions

16:52

either totally or after a certain number

16:54

of weeks more are expected to

16:56

follow good you say

16:58

the high level what is abortion care and tail

17:01

your abortion and terminating

17:03

and pregnancy statistically it's in

17:06

the first trimester that trimester that

17:08

often happens to very or in a

17:10

burden think it's it's early enough

17:12

that can be done with medication which is typically

17:14

the safest and best option but

17:16

early surgical interventions

17:19

the door interventions are very very

17:21

face abortion care is some of the safest

17:23

care that provided throughout all of madison

17:28

then there are very complex areas

17:30

of rare and since

17:32

there were people who actually

17:34

like to continue her pregnancy find

17:37

later on that they are facing

17:39

either a situation where a fetus

17:42

developing has no chance of survival

17:44

very little chance

17:45

the bible or that they themselves

17:47

have become ill with various conditions

17:49

that make

17:50

during the pregnancy to term

17:52

incredibly dangerous and life threatening

17:54

and so those what him files a provision

17:57

of a later term abortion to

17:59

a sexually the how about

18:01

result and then finally ecstatic

18:03

pregnancies can be treated with medication

18:06

which is an abortion and or were surgical

18:08

means which is also technically an abortion

18:11

it sounds to me like you would describe abortionists

18:13

healthcare

18:14

one hundred percent it's essential health care ob

18:17

gyn has always been at the center as

18:19

attacks mainly because of the focus

18:21

and abortion and

18:24

how we provide that care can we provide

18:26

that care that pervades everything

18:30

the emphasis is someone who sees

18:32

and treats women ,

18:35

what trade offs do you see when you think

18:37

about that autonomous decisions

18:39

than rights that women have

18:41

i believe that as human beings

18:43

we each have the right to bodily

18:45

autonomy i should be able to

18:47

decide for example if you needed

18:49

a kidney

18:50

save your life other i'm money give

18:52

you one are not from my own body

18:54

giving you my kidney is actually less risky

18:57

for example of i chose to carry a pregnancy

18:59

to term

19:00

and have a child

19:01

that's incredibly risky still despite all

19:03

of our advances

19:06

though at the end of the day

19:07

want every human being to be able to

19:09

make those choices that trade off

19:11

is that when i decide not

19:14

to give you my kidney you will

19:17

or not to give you blood potentially

19:20

if you're in a horrific car accident

19:22

and you need enough blood to survive

19:24

and we don't have enough you will die so

19:27

if we all had a different conceptualization

19:30

of our bodily autonomy where we would

19:32

be required to give of ourselves in that

19:34

way then i might

19:36

perhaps have a different idea of how i see

19:38

these bodily autonomy bread

19:40

the person who can become pregnant

19:42

but given that we have centuries

19:45

of this and where you

19:47

can decide if you're going to give yourself

19:49

in that way i think we should maintain

19:52

those who also have you try and

19:54

can carry pregnancy

19:56

i don't begin economists would be able

19:58

to put it as eloquent

19:59

that kind of you

20:03

abbott it's very early to think

20:05

about what the legal

20:07

ramifications will be for providers

20:09

after the dobbs isn't particularly in states

20:11

where the , have changed

20:14

but you have through any insight

20:17

at least based on your colleagues

20:19

who may practice in the states

20:21

have certain heard anecdotes but haven't seen think systematically

20:24

described it as to how providers

20:27

use about the safety of

20:29

themselves providing abortion care of changed

20:31

my knowledge of the law allowed me

20:34

to understand that anybody who is

20:36

in one of those states has carefully trying

20:38

to negotiate the laws and stay

20:40

within them as much as they possibly can

20:42

even though that

20:43

the compromises their delivery of standard

20:45

care

20:46

cause if you're charged with felony

20:49

you immediately stop practicing

20:51

it's not like you can have a cell any hanging over

20:53

your hiding continue to provide medical care

20:56

your license now suspended and

20:58

these laws apply to everybody

21:00

provide care so for surgical

21:03

the nation that anesthesia

21:05

nursing the physician themselves

21:08

does it apply as market transport

21:10

how coming are they all charge

21:13

how many people are we taking out of circulation

21:16

to fight these saw any charges

21:18

while decimating and already

21:20

incredibly strange healthcare

21:22

thing so i

21:25

understand why providers are very

21:27

carefully trying to figure out how to provide

21:29

care with in these laws

21:35

if i'm only wearing my lot

21:37

fat

21:38

then i would say oh but me want to challenge

21:40

the laws but again

21:42

tapping a lot of any endeavor

21:44

the person to be the tough case to remove

21:47

themselves from

21:48

after leaving their patients behind and

21:50

not to mention

21:51

there's no consequences of that they might permanently

21:53

they're like and they probably have a family to

21:55

care for such their livelihoods

21:58

that's livelihoods that's

21:58

if an individual per

22:00

the potential repercussions here for doctors

22:03

are enormous and i think it's helpful

22:05

to think about well how would doctors

22:07

respond to legal

22:10

risk in situations which are

22:12

far less extreme let's

22:14

step away from abortion care but there's all sorts

22:16

of other things that obese you a and do debt

22:20

lead to concerns and that's

22:22

about malpractice liability and how

22:24

does provide behavior change when they're worried

22:26

about those issues

22:27

the classic example of what you're describing

22:29

his

22:30

for that delivery the liability

22:32

for forceps delivery and

22:34

the typically for birth injuries and break

22:36

your success injuries that stretch along

22:38

the nac that than can lead to palsy

22:40

not being able to move your arm

22:42

that can happen as you put forceps or

22:44

the had ever and sent and pull them

22:46

against the vaginal canal pulling

22:48

their shoulder

22:50

polling that nervous structure and and

22:52

then that

22:53

prompted a lot of defensive medicine

22:55

more his ear infections likely because

22:58

people were trying to avoid those injuries

23:00

it wasn't solely in response to litigation

23:03

but the malpractice insurance

23:06

costs went so high that

23:08

many people had to leave practice close states

23:10

thought entire of eg

23:12

when department completely

23:14

mt

23:15

because of these litigation rest and because

23:17

of the high cost associated with them

23:19

the end of the day again with that led to

23:21

was hires very and sex and race and now we're

23:23

dealing with them

23:25

hundred out of that which is that multiple

23:27

syrians are actually quite dangerous they can

23:30

lead to a condition called the center

23:32

a cretin all kinds of problems associated

23:34

with that we want to now decrease the says

23:36

the infection rate and we're working hard

23:38

to do that

23:39

when you figure defensive medicine will work classically

23:41

thinking about is doing more

23:44

to avoid the sort of liberty but

23:46

the mirror image of that is

23:49

sometimes referred to as avoided medicine and that

23:51

actually is , closely

23:53

related to this issue of what providers made

23:55

do in response to dobbs do

23:58

doctors avoid certain time the

24:00

procedures because they're worried about liability

24:03

or some of the implication performing that procedure

24:06

there's so many areas in the

24:08

house for persons who identify as women

24:11

for trans man

24:13

where

24:14

many many providers are not affording

24:17

and all the care that they have

24:20

sometimes that

24:21

the stigma issues and sometimes it's lack

24:23

of training and sometimes it's avoiding

24:26

liability around

24:28

this is a very hard questions speculate on

24:30

but as , think about where

24:32

obe be was thirty or forty

24:34

years ago where it is now and where

24:36

will be in the future i'd

24:39

like to get your thoughts on the supreme

24:41

court ruling what impact

24:43

he may have on the training resident

24:45

physicians do we think that fewer people will

24:47

want to enter the theater more people

24:50

that's a great question again we need a little bit

24:52

more data for me to answer some truly

24:54

speculating

24:55

i think that

24:56

is going to be a large proportion of people who

24:58

do not use to go into obstetrics and gynecology

25:01

because of this ruling

25:03

because the answer

25:04

the of what training they've be afforded or the

25:06

uncertainty about their practice would be

25:08

there's going to be a small set of people who were

25:11

fired up and choosing it specifically

25:13

to fight the site and that's great but

25:15

we will have fewer people applying

25:18

people applying

25:19

and you can imagine that there would be long

25:21

term ramifications and

25:23

spillover effects from then them into for example

25:26

many women receive their

25:28

primary care through obese so

25:30

we have fewer obese training because

25:33

of this particular ruling

25:35

negative spillover effects and women in ways

25:38

that are completely unrelated actually to abortion

25:40

care and many of those women

25:42

receive their preventative care three planned parenthood

25:45

because they don't have insurance get they

25:47

can get free preventative care there

25:50

though all of those people are

25:52

going to have fewer access points

25:54

at which they can get the care they need

25:58

it's hard to predict what the future

26:00

will bring when it comes to have a dobbs decisions

26:03

will impact minister we do

26:05

know is that the law influences

26:07

the way doctors deliver care and

26:09

sometimes is a delivery at all there's

26:12

a lot for reproductive health specialist to

26:14

consider these days and clarity

26:16

isn't exactly around the corner here's

26:19

michelle mellow again

26:20

my sense is that we're in the worst of

26:22

it right now because there's so

26:25

much uncertainty among physicians about what

26:27

exactly they're state requires what

26:29

exactly they're allowed to do i've

26:31

certainly heard of effort with and hospitals

26:33

to try to clarify these matters and adopt policies

26:36

and provide information to their staff

26:38

i do hope and maybe optimistically

26:41

expect there will be more efforts

26:43

from professional organizations to help providers

26:45

anderson in the law to

26:48

help them navigate some of that is

26:49

that are a rising now with

26:52

electronic health records how to minimize

26:54

potentially incriminating information in the medical

26:56

record and other things like that

26:59

that's it for today show i like to thank my

27:01

guess michelle mellow and louise king

27:04

and thanks to you of course for listening coming

27:07

up next week a pandemic is

27:09

changed is changed about medicine including

27:11

how we've gotten care it's not

27:13

that telemedicine didn't exist before

27:15

the pandemic it just was happening in theory

27:18

small numbers when kobe hit

27:21

telemedicine use in the us exploded

27:23

things were moving quickly and there wasn't time

27:26

to consider with the implications of this

27:28

could be is any

27:30

it may actually be something more adherents

27:32

it is the telemedicine experience that

27:35

makes essentially less assists and stamps

27:37

and he of the

27:38

it might have care telemedicine

27:40

, generated a lot of excitement in healthcare

27:43

it may delivering care to patients convenient

27:45

and safe during a scary time time

27:48

as of a doctor's jobs and easier

27:51

that next week on freakonomics md

27:54

for economic m d is part of

27:56

the freakonomics radio network which

27:58

also includes for economic

27:59

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28:02

people i mostly admire all

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, souls are produced by sitter and

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when but radio you can find us

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28:11

bob who had this episode

28:14

was produced by julie can for and

28:16

next by eleanor osborne with

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help from south and cleaner he also

28:20

had health this week some weird sodas and

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28:27

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28:29

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28:33

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28:34

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28:36

know original music composed

28:38

by louis hall if he wants

28:41

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28:43

in this economics radio network

28:45

he recommended here family

28:59

the really has been

29:01

writing to me in our chat that the editing

29:03

will be easy for this episode and

29:05

i wrote back it's because their lawyers well

29:07

i think my students would agree that most

29:10

lawyers need to be edited heavily

29:12

were paid by the word

29:18

ahmed radio now

29:19

where a hidden

29:31

when i caught out of the hospital at six pm

29:33

i'm not done for the night stephen game hundred

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forty clock and she's that was

29:37

like sure i'm playing a thirteen

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year old is great and level fifty three

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made with a seal

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not too i need to stay on top of my game

29:45

that's when i crack open a heineken zero zero

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zero alcohol but just as refreshing

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so i can focus

29:51

the when he told for his mom tell

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them it's a time for lieutenant good sign it

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and zero zero zero point zero percent alcohol

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now you can must be twenty months to purchase

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