Defensive medicine epidemic costs billions in dollars, untold expense to physician-patient relationship

Physicians are nearly unanimous in their opinions that the practice of defensive medicine not only runs rampant throughout all specialties, but that tort reform is needed to decrease malpractice lawsuits and unnecessary testing, according to a new survey published in the Archives of Internal Medicine.

Researchers from Mount Sinai School of Medicine in New York City reported that, overall, 91 percent of the 1,231 doctors who responded to their survey "reported believing that physicians order more tests and procedures than needed to protect themselves from malpractice suits." That view was held by the vast majority of generalists (91 percent), medical specialists (89 percent), surgeons (93 percent) and other specialists (94 percent), with slightly more men (93 percent) agreeing with the statement than women (87 percent).

In addition, 91 percent of respondents also answered affirmatively to the question, "Are protections against unwarranted malpractice lawsuits needed to decrease the unnecessary use of diagnostic tests?"

Survey co-author Dr. Tara Bishop, an internist at Mount Sinai School of Medicine in New York, suggested to the Associated Press that the results were not surprising. "When you sit around at a dinner party with doctors, malpractice fears and a kind of hatred of the malpractice system really comes up as a common theme," Bishop said.

Indeed, Paul Perantinides, a medical malpractice attorney in Akron, Ohio, told the AP that most of his cases involve doctors failing to test--a point that Bishop said emphasizes why doctors, herself included, sometimes order so many tests.

And although physicians in lower-risk specialties such as general internal medicine and pediatrics are much less likely to be sued for malpractice than OB/GYN specialists and emergency physicians, their fear is just as real, Bishop told Medscape Medical News. "There's just a visceral response to the word 'malpractice,'" she said. "The entire medical community worries about being pulled into a lawsuit."

This collective fear results in an annual tab of anywhere from the $60 billion estimated by the U.S. Department of Health and Human Services to $200 billion alleged by the American Medical Association or even PricewaterhouseCoopers' calculation of $210 billion--the latter figure representing 10 percent of all healthcare spending.

Beyond the financial cost, defensive medicine also comes at the expense of the physician-patient relationship, according to Richard Jackson, chairman and CEO of Atlanta-based Jackson Healthcare. In an editorial for H&HN Magazine, he ranked medical malpractice as the No. 1 barrier between physicians and patients, citing a Gallup survey in which 73 percent of physicians across the country and all specialties reported practicing defensive medicine to protect themselves from lawsuits. Further, the respondents estimated that 26 percent of overall healthcare costs can be attributed to defensive medicine.

In a parallel online study of over 3,000 physicians, Jackson found that the consequences of defensive medicine also result in physicians' limiting access to care for high-risk patients, inadequate treatment of patients with life-threatening illnesses, as well as distrust among patients and their physicians.

"We need a balanced, common sense approach to bridging the physician-patient divide, one that guarantees patients their rights without undermining their care," Jackson writes. "Likewise, we need to trust physicians again, and we need a system that incentivizes this trust. It's not fair to have a few opportunists handicap the majority of physicians who practice ethical medicine. Reform that addresses defensive medical practices is an important first step toward freeing physicians to practice high-quality, resource-efficient medicine and truly partner with their patients."

To learn more:
- check out this Associated Press article in the Los Angeles Times
- see the post in the Wall Street Journal Health Blog
- read the piece in Medscape Medical News
- here's the abstract in the Archives of Internal Medicine
- and here's a related editorial in H&HN Magazine

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