A 2010 study performed by the Harvard School of Public Health estimated that the total cost of medical malpractice claims in the U.S. was $55.6 billion, of which $45.6 billion was spent on defensive medicine. The fact that almost 2.4 percent of the nation’s entire health care expenditure is spent on redundant, often ineffective treatments and tests is not surprising to most of the medical community which has decried the scourge of spurious malpractice claims for decades.
Defensive medicine has long been a fixture in the practice of medicine. In some cases, it involves performing services that are unnecessary, and, in others, prevents providers from performing potential beneficial procedures that also risk exposure to litigation.
Let’s say a healthy 18 year old male is diagnosed with the flu. He is also coughing nonstop, a known symptom of the flu, which is causing soreness in his ribs. The doctor may order a CT scan of his chest, even though he/she is 99.9% confident it is nothing of concern.
The physician bypasses his own expertise, in order to prevent a potential lawsuit. This is an example of defensive medicine.
The consequences of practicing defensive medicine include a higher financial cost to patients, lower quality of care, and a degraded physician-patient relationship.
In one study of 800 Pennsylvania physicians, 92 percent ordered imaging tests and diagnostic procedures merely for confirmation. Among this same population, 42 percent avoided patients with health complications as well as performing procedures with an elevated risk.
Defensive practices are all too common among physicians who are desperate to avoid stressful, costly litigation. Although other factors also undergird the practice of defensive medicine including genuine concern about patient welfare, over-utilization of private insurance and an organizational interest in maximizing patient care revenue, potential lawsuits is the primary component of the defensive medical culture; one report on California ER physicians from 2001 to 2005 found that 50 percent performed their duties in a manner designed to minimize malpractice litigation.
What may be a more compelling factor than the threat of litigation are physician and patient expectations. Many clinicians are eager to use a greater array of diagnostic procedures when confronted with patient experiencing severe pain events. While many physicians are willing to explain how additional testing may only produce confusion, most tend to surrender to patient requests for more tests and treatments.
Unfortunately, the specter of malpractice has been a component of practicing medicine for so long, that defensive medicine has become too entrenched to remove. Many in the medical and, especially, the insurance industries have pointed to tort reform as a solution. While the number of claims and malpractice insurance premiums have dropped in states where tort reform has passed, it hasn’t diminished the practice of defensive medicine.
Texas, Georgia and South Carolina passed laws that insulated ER doctors from lawsuits almost ten years ago. After examining almost 3.8 million ER visits in these three states and others without such laws, researchers found that ER physicians under tort protection ordered almost an identical number of MRIs and CAT scans as those physicians serving without such protections.
Defensive medicine is endemic to modern health care, and because it is a multidimensional issue, it is unlikely to be resolved with a few policy changes. Medical education must be re-attuned to the financial realities of patients, and there must be a decisive change in the professional culture that rewards too much patient care.
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