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Defensive Medicine Widespread, with Serious Consequences David M. Studdert, William M. Sage, et al.
Journal of the American Medical Association (JAMA), June 1, 2005
"Defensive behaviors may reduce access to care and even pose risks of physical harm. Because both obstetrics and breast cancer detection are high-liability fields, women's health may be particularly affected." |
Do doctors really practice defensive medicine, and does defensive medicine hurt the quality of healthcare? According to a new study published in the Journal of the American Medical Association (JAMA), the answer to both questions is a resounding 'yes.' In a survey of Pennsylvania physicians, researchers found that to avoid a lawsuit:
93 percent reported practicing defensive medicine;
92 percent reported ordering unneeded tests and diagnostic procedures and making unnecessary referrals;
42 percent said "they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious."
The study was conducted and co-written by leading experts in healthcare and law, including David M. Studdert, L.L.B., Sc.D., M.P.H., of the Harvard School of Public Health, and William M. Sage, M.D., J.D., a Columbia Law School professor and Principal Investigator for the Project on Medical Liability in Pennsylvania.
Defensive medicine is "a deviation from sound medical practice that is induced primarily by a threat of malpractice suits." Forty-three percent of physicians said their most recent defensive act was "using imaging technology in clinically unnecessary circumstances."
Imaging studies are often costly, but the financial costs of defensive medicine are only part of the problem, as the researchers emphasize:
The most frequent form of defensive medicine, ordering costly imaging studies, seems merely wasteful, but other defensive behaviors may reduce access to care and even pose risks of physical harm. Because both obstetrics and breast cancer detection are high-liability fields, women's health may be particularly affected.
Lawsuits make it nearly impossible for healthcare providers to balance the interests of all patients; some patients receive unnecessary tests only to rule out a remotely-possible condition, while others with unquestioned need have trouble finding care. All Americans pay higher costs because of defensive medicine.
The solution is to make medical justice reliable, so that physicians know what is necessary to meet the standard of care and what is an unnecessary cost. Today, the standard of care is determined on an ad-hoc basis, changing from one jury to the next.
In an editorial published in JAMA along with the defensive medicine study, Peter P. Budetti, M.D., J.D., of the University of Oklahoma Health Sciences Center, argues that we must create a legal system that supports good medical care:
[T]he tort system ... seems to engender perverse behaviors such as widespread, sometimes serious, and often costly deviations from accepted medical practice, and internal self-monitoring by the medical profession evidently permits such behavior to occur on a large scale. Most important, the pattern of tort reforms pursued to date has not led to innovative legal approaches that serve both the profession and patients by tying liability law restructuring to systemic, evidence-based changes in medical practice that ensure adherence to not deviate from good medical care.
What is needed is to link new approaches to legal accountability with mandatory active participation in advanced, systematic measures to ensure high-quality care. ... Regardless of how fanciful this may sound in the face of entrenched contrary experience, now is the time for the disparate and opposing forces to find a way to focus together on 'the large number of patients who die unnecessarily each year from medical errors' rather than a continuance of actions reflecting the visceral antipathy of many physicians and lawyers to one another.
Common Good has proposed special health courts to make medical justice reliable--an idea endorsed by Senate Majority Leader Bill Frist, M.D., and the Progressive Policy Institute. Read more.
Click to read the press release for the defensive medicine study.
The full study is available to subscribers and may be purchased by others on JAMA's webpage.
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