By: Dr. Ken Teufel
Doctors are often criticized for practicing "defensive" medicine -- doing an excessive number of tests and procedures, or admitting patients to the hospital when it's not medically necessary -- "to cover myself in the event of a malpractice claim." The sole purpose of defensive medicine is to reduce the likelihood of being sued, not to improve either diagnosis or treatment. Most doctors in the United States admit to practicing defensive medicine, at an estimated cost of $60 billion annually.
We know that surgical specialists are five times more likely to be sued than their non-surgical colleagues. We also know that doctors who lack effective communication skills are at greater risk as well. What no one has shown (until now) is whether or not practicing defensive medicine can decrease the number of malpractice claims. A recent study says yes, it can (published online in the British Medical Journal, November 4, 2015).
"Researchers tracked more than 24,000 Florida physicians over a nine-year period and found that in six specialties, doctors who spent the most health care resources on hospitalized patients had the lowest likelihood of being sued" (Washington Post, November 4, 2015). Internal medicine doctors whose patients had the highest hospital charges had a 0.3 percent chance of being sued for malpractice. Those internists whose patients had the lowest charges were five times more likely to be sued. A similar pattern was found for surgeons, obstetricians, and pediatricians. Family medicine was the only specialty not showing this association, according to the study's lead author, Dr. Anupam B. Jena of Harvard Medical School.
Taken at face value, one might conclude that practicing defensive medicine is a good thing, something to be encouraged. This study, however, did not look at whether or not practicing defensive medicine resulted in better patient outcomes or fewer errors. The study's purpose was to simply compare the incidence of malpractice suits between high-spending physicians and low-spending physicians. Those who used more resources came out the clear "winners."
But, maybe there was something else at play here. Could it be that the patients who received more expensive diagnostic work-ups and treatment were of the mindset that everything possible had been done for them? In other words, they couldn't come up with a good reason to find fault with their care. It stands to reason, too, that malpractice attorneys would be reluctant to take on such cases.
This study comes at a time when new payment systems actively discourage the practice of defensive medicine. As noted in the Washington Post article: "Cutting back on truly excessive testing and procedures will benefit everyone, but any individual person might feel uncomfortable with the idea the doctor might be holding back on care for any reason. Doctors, on the other hand, may be reluctant to curb spending since it may protect themselves against accusations of malpractice." The obvious question yet to be answered: Will health care reform, with its emphasis on cost-cutting, increase malpractice suits?
About the author: Dr. Ken Teufel is the medical director at Interim Physicians, a pioneer locum tenens physician staffing firm based in St. Louis, MO that has provided quality physician coverage to hospitals, clinics and other healthcare facilities since 1979.