Fear of Malpractice Claims and Defensive Medicine

Few things unite physicians as much as the belief that the current malpractice tort system is seriously broken. The litany of complaints is long and familiar: many suits are without merit; the cost of malpractice defense forces settlements even when the “medicine” was good if the outcome was bad; lawyers take too big a slice of the financial pie; we are all forced to practice defensively to avoid getting sued, thereby driving up the cost of health care. Of all of these, the belief that malpractice fear drives physicians to overtest and overtreat seems nearly universally held. Even so, there has been very little evidence to support it, and efforts to quantify the impact of “defensive medicine” on health care costs have been largely speculative.

That is why a paper in the most recent issue of Health Affairs caught my eye. In it (Health Aff August 2013 vol. 32 no. 8 1383-1391) researchers from a DC think tank, an academic health center, and the Harvard School of Public Health, used a novel methodology to probe the relationship between individual physicians’ concerns about malpractice and their actual practice patterns.

In prior studies, researchers typically compared practice patterns among states with differing malpractice environments. The authors of the current study argue persuasively that such an approach is insensitive to individual physician practice, and that geographic practice variability has many other potential causes, making it difficult to tease out the specific impact of malpractice policies. Instead, they were able to correlate individual physician responses on a validated national survey to their actual (Medicare claims based) practice patterns for a limited number of clinical conditions that are commonly seen in clinical practice, and for which there is considerable variation in practice. Those conditions were chest pain, headache and lower back pain.

The principal finding of the study was that: “physicians who reported concern about their malpractice risk and who evaluated patients visiting their offices with chest pain, headache, or lower back pain were significantly more likely to order certain diagnostic tests, a pattern consistent with the practice of defensive medicine.”

This seems to me to be pretty big news, and supplies some much need data to the strong sentiment among physicians that successful health care cost containment strategies must include meaningful malpractice tort reform.

What do you think?

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