ER docs order tests to avoid lawsuits first, help patients second

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A patient's best interests may not be motivating emergency room doctors to order tests as much as self-protection from medical liability lawsuits, a new survey from the American College of Emergency Physicians finds. More than 50 percent of roughly 1,800 ER doctors said the main reason they order the number of tests they do is fear of being sued.

Until such fear is alleviated, overtesting is likely to continue to cost big bucks to patients, as well as the overall healthcare industry. Almost 49 percent of ERs docs said diagnostic testing accounts for the biggest expense on a patient's ER bill.

Moreover, such defensive medicine can cost anywhere from $60 billion to $151 billion a year, according to ACEP President Sandra Schneider. "That dwarfs total expenditures on emergency care, which at $47.3 billion in 2008 represented just 2 percent of all healthcare spending," she said in a statement.

In order for hospitals to trim expenses, they must address medical liability issues, as 44 percent of ER docs consider fear of lawsuits the biggest challenge to cutting ER costs.

While defensive test ordering is boosting costs, it also--more alarmingly--is endangering patients' health. Recent studies have shown that the use of CT exams in emergency departments has significantly increased, along with the exposure to high-dose ionizing radiation.

ACEP suggests that hospitals look to tort reform enacted in Texas, which capped non-economic damages and saw a drop in healthcare costs and an improvement in patient safety.

Dr. Arlo Weltge, a Texas-based physician, agrees, saying the state's reform changed how he practices medicine. "Now if a young patient comes in with what is essentially a bonked head, I feel like I can have a reasonable discussion with the parents without feeling pressured to order a test," he told the Huffington Post.

For more:
- here's the ACEP survey (.pdf)
- read the ACEP press release
- read the Huffington Post article

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