Defensive Medicine

As published in the Kansas City Star

"Malpractice fears put doctors on defense"

A survey published today in The Journal of the American Medical Association found that 93 percent of doctors in high-risk specialties in Pennsylvania engage in such defensive practices as ordering unnecessary medical tests, avoiding risky procedures and even refusing to treat litigious patients.

...researchers from Columbia and the Harvard School of Public Health surveyed 824 Pennsylvania physicians in six high-risk specialties, including obstetrics, neurosurgery and emergency medicine. The researchers chose Pennsylvania because physicians there have been hit particularly hard by rising malpractice insurance premiums.

Fifty-nine percent of the surveyed physicians said they often ordered more tests than were medically indicated, 52 percent often needlessly referred patients to specialists and 32 percent often suggested invasive procedures such as biopsies to confirm a diagnosis.

Thirty-two percent of physicians said they often avoided performing certain procedures. For example, some obstetricians had quit delivering high-risk babies, some radiologists had stopped reading mammograms and some neurosurgeons had refused to treat trauma cases.

Thirty-nine percent of doctors said they often avoided treating patients they thought were more likely to sue, such as patients covered by workers' compensation or medical assistance programs.

More, from WebMD

Harvard researcher David M. Studdert, LLB, ScD, MPH, and colleagues went to a state -- Pennsylvania -- in the middle of a malpractice insurance crisis. From 2000-2003, several major insurers left the state. Premiums for medical liability policies shot up.

Studdert and colleagues asked 825 doctors from the six specialties at highest risk of malpractice lawsuits -- emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology -- to answer pointed questions about how they practiced medicine.

The bottom line: 93% of the doctors say they practice "defensive medicine." It means that to protect themselves against possible malpractice lawsuits, doctors do two things. On the one hand, they may order what they feel are additional yet unnecessary tests and procedures. On the other hand, they may distance themselves from treatments -- and patients -- that might put the doctors at risk of a lawsuit.

Studdert's team found that:

92% of the doctors ordered tests, diagnostic procedures, or referrals for specialist consultations that they did not think were needed.
43% of the doctors say they ordered imaging tests they didn't think necessary.
42% of the doctors stopped performing procedures prone to complications (such as trauma surgery), avoided patients with complex medical problems, or avoided patients they thought might be likely to sue them.