5-Year Study to Focus on Defensive Medicine

In recent decades, there has been a public outcry against the supposed rising medical costs due to defensive medicine. But the National Institute of Health (NIH) has awarded a $2 million grant to George Washington University researcher Steven Farmer, M.D., Ph.D., to study the effects of defensive medicine.

The grant will allow Farmer to spend the next five years researching the effect that the risk of malpractice liability has on physicians in general, and on cardiovascular testing in general. The key focuses of his study will be on (1) patient benefit of the testing; (2) financial incentives; and (3) malpractice liability.

Critics focus on costs on defensive medicine

Defensive medicine refers to actions that physicians make in response to a threat of medical liability. Critics argue that many medical malpractice lawsuits are frivolous, but still have the effect of increasing the cost of medical care because it leads physicians to order unnecessary tests or take other actions that pad the medical bill when they do not honestly believe there is a benefit to the patient.

A 2010 survey of doctors does link a raise in medical costs to defensive medicine. For example, the participants linked 34 percent of overall healthcare costs to defensive practices.

The desire to avoid lawsuits accounted for:

• 35% of the diagnostic tests they ordered
• 19% of the hospitalizations
• 14% of prescriptions they had written
• 8% of surgeries performed

Of the responding physicians, 9 out of 10 admitted to practicing positive defensive medicine – such as taking additional steps they believed unnecessary, like ordering additional testing – within the prior year. Another 42 percent of responding doctors reported practicing negative defensive medicine – avoiding patients with complicated problems and declining risky procedures – to avoid medical liability.

Medical liability reform has little effect on defensive medicine rates

On the other hand, according to a recent study in the New England Journal of Medicine, laws insulating medical professionals from liability do not make a difference in the care provided. The study focused on emergency room doctors, who would be likely candidates to practice defensive medicine – they must make rapid decisions with limited information, while having a host of resources available. The researchers compared emergency department visits to hospitals in states with medical malpractice reform legislation to visits in states without the reform.

The reform statutes insulated emergency room personnel from liability except in cases of gross negligence. Rather than decrease the imaging rates, average charges, or hospital admission rates, the reform statutes largely had no effect. In eight out of the nine studied, liability reform statutes had no effect on the factors such as rates of testing ordered and hospital admissions. In one state, Georgia, reform legislation led to a 3.6% reduction in per-visit emergency room costs.

Possible benefits of defensive medicine

While many people focus on possible increases in financial cost, defensive medicine may also come with some benefits, including:

• Readiness to refer a client to someone with more expertise
• More thorough diagnostic testing
• Increased patient trust in their doctor’s diagnosis

The GWU study is slated to offer a more comprehensive view of the factors, including the benefits to the patient and financial incentives built into the system.