Defensive medicine may curb malpractice claims, study finds

By Aine Cryts

When a physician chooses to order more imaging exams or labs, he or she may be practicing defensive medicine--or maybe not. The potentially unnecessary tests and procedures increase the cost of care, but they can also reduce the chance that the physician will get hit with a malpractice suit.

A study published in The BMJ reveals that physicians with the highest hospital charges also had fewer malpractice claims. The study includes data from 2000 to 2009 on malpractice claims filed in Florida, in addition to hospital discharges and physicians' specialties in that state.

Obstetricians who delivered more babies by cesarean section--which may be evidence of the practice of defensive medicine--were also less likely to be sued for malpractice, according to the study.

"The study shows that we need to understand better defensive medicine, including how to define and reliably measure it and how this type of practice affects both patients and doctors," wrote Cornell professors Tara Bishop and Michael Pesko in an accompanying opinion piece. 

While ordering more tests and labs isn't necessarily proof that physicians are practicing defensive medicine, there could be a link. And defensive medicine doesn't come cheap. It costs as much as $60 billion dollars a year, according to a 2010 study published in Health Affairs.

Efforts to reduce utilization may be met with "sluggish opposition if the unintended effect of reduced utilization is increased malpractice risk for the physician," Anupam Jena, M.D., Ph.D., the study's author told The New York Times Well blog.

Seventy-five percent of doctors say their colleagues order one unnecessary test or procedure each week, FiercePracticeManagement previously reported. 

The top reasons doctors give for ordering potentially unnecessary tests and procedures include:

  • Malpractice concerns (52 percent)
  • Being extra-cautious (36 percent)
  • Access to additional information is reassuring (30 percent)
  • Patients insisted on unnecessary procedure (28 percent)
  • Let their patient decide (13 percent)
  • Driven by fee-for-service system (5 percent)

To learn more:
- read The BMJ study
- here's The BMJ commentary
- check out the New York Times' Well blog post

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