June 10, 2005
"Defensive medicine" is an inclusive term meaning the ordering unnecessary tests and the passing off of complicated patients to stall the filing of malpractice lawsuits. Unfortunately, the rising use of defensive medicine is impeding patient care, says the Journal of the American Medical Association (JAMA).
The Pew Charitable Trusts surveyed 824 physicians in Pennsylvania. The doctors involved came from six high-risk specialty practices and 93 percent said they practice some from of defensive medicine.
- Some 59 percent said they often ordered more diagnostic tests than necessary, while 52 percent referred patients to other specialists even if the referral was unnecessary.
- Some 42 percent said liability concerns had forced them to restrict some practices since 2000, including eliminating procedures prone to complications, avoiding patients with complex medical problems and avoiding patients who appeared litigious.
- Physicians in the field of obstetrics, gynecology and radiology report limiting services, such as reading mammograms.
Higher levels of defensive medicine are part of the social costs of instability in the malpractice system. 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, explains JAMA.
Because both obstetrics and breast cancer detection are high-liability fields, women's health may be particularly affected. Efforts to reduce defensive medicine should concentrate on educating patients and physicians regarding appropriate care in the clinical situations that most commonly prompt defensive medicine, developing and disseminating clinical guidelines that target common defensive practices, and reducing the financial and psychological vulnerability of individual physicians in high-risk specialties to shocks to the liability system, says JAMA.
Source: Christopher Snowbeck, "Doctors admit to defensive medicine," Pittsburgh Post-Gazette, June 1, 2005; based upon: David M. Studdert, "Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment," Journal of the American Medical Association, June 1, 2005.
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