DEFENSIVE MEDICINE

Is your doctor putting you through unnecessary tests, even biopsies, say, simply because he or she fears being sued? According to the results of a new survey, the answer is a concerning yes!

Defensive medicine may be a subtle issue, like getting a couple of extra blood tests done, or being sent to another doctor for an extra opinion. Or, it might be something as serious as not having access to a doctor for an important procedure. But there’s no question, lawsuits are affecting both doctors and patients in negative ways.

A new survey published in the latest Journal of the American Medical Association, shows doctors are playing the medical analogy of the prevent defense: they’re doing everything they can not to get sued, at the monetary expense of the patients and medical insurers.

Dr. Bernard Rosof, Senior Vice-President of Corporate Relations at North Shore/LIJ Health System says, “We are in a pickle. I think that the liability crisis situation in this country has really created an environment that has encouraged defensive medicine.”


According to the survey of doctors in Pennsylvania--a state known for its high malpractice awards--those in five highly targeted specialties are almost unanimously practicing--or not practicing as the case may be--correct textbook medicine.

The vast majority--90 percent--of those in radiology, surgery, neurosurgery, emergency medicine, and obstetrics admitted to defensive medicine practices. These included ordering more tests than needed, and referring to another doctor when it was truly unnecessary.

A third ordered more medication than needed.

The most frequent form of defensive medicine cited was ordering unnecessary imaging studies, like CAT scans or MRIs. While this might not seem to be a big issue, these tests are costly, and as more and more doctors order these unnecessary tests in similar case situations, the authors say what had at one time been inappropriate test ordering becomes the legal standard of care, and if not ordered, becomes a target in a malpractice case.

Even worse, there were many who said they admitted patients to the hospital just to be on the safe side, when it really was not necessary. Others ordered biopsies that were likely superfluous.

Dr. Elliot Goodman, a bariatric surgeon says overkill is common, and in fact, the doctors are to blame in many cases.

“You’re treating the chart as much as the patient. A lot of physicians go beyond the bare minimum set by the hospital, because of these one in a hundred thousand cases,” states Dr. Goodman.

Almost 40 percent said they will or already have stopped caring for high risk patients. Eleven percent of the doctors said they were stopping practice altogether because of the malpractice issue.

Why? 88 percent had been sued at one point, and almost half had been sued in the previous three years.

The big concern here for patients: those in rural areas may be at risk for limited access to key services, such as mammograms and obstetrical care.

“Physicians are sued not for bad practice but bad outcomes, and those bad outcomes are not under the control of the physician. If there was a more judicious, rapid and fair way to compensate individuals who are injured by the system, I would see that as a goal we should all try to achieve,” Dr. Rosof states.

It’s a battlefront that, like most cases of war, will end up with a similar conclusion if the issue fails to be addressed: everyone, from patients, and doctors, to insurers, and even lawyers, will come out losers.

For more information on defensive medicine, and to read the study, go to
http://pubs.ama-assn.org