Is Defensive Medicine Really As Big An Issue As Physicians Claim?

A recent report from a well-known medical journal states that most physicians think that defensive medicine is creating billions of dollars in costs for the United States each year and that they are need of protections from medical malpractice suits. But does this really make sense?

There is little doubt that U.S. patients go through much more testing and procedures than other countries.  Further, the U.S. has not demonstrated any benefits from it in our health statistics compared to other countries that have much less expensive health care.

Physicians generally report that their colleagues order additional and unnecessary testing because they fear that the patient will sue them if they don't order the tests.

This seems to be a rather weird admission.

In order to receive payment, physicians must attest to the need of any test that is ordered by them.  So, when doctors order these so-called defensive tests on the basis of protecting themselves, they are actually committing insurance fraud.

Obviously, if there is even a remote chance that a test can aid the patient by uncovering an issue that can be treated, then the test was needed and really doesn't come under the category of defensive medicine.  However, a lot of physicians believe that it is solely the additional threat of facing a lawsuit for not ordering the test that provides the catalyst for ordering it.

A recent post from The Wall Street Journal, by Katherine Hobson on her health blog, drew some interesting comments from readers. One patient stated:

"I have read comments here with interest. I have had a doctor tell me he was ordering a test on me more out of a fear of being sued, and that it “was probably not necessary.” I was shocked. I said, “Doc, you are telling me that if I have a brain tumor, and die, that is not a serious enough risk for me to have an MRI, UNLESS YOU COULD BE SUED FOR IT!” I had some severe headaches.

The doctor turned red with embarrassment, and perhaps shame. He apologized and said he did not realize what he was saying. He could only be sued if turned out to have a serious medical problem that could have been prevented by the test. He was admitting that my life was not enough motivation for the test, but if he could be sued for the lost of my life; then it was good motivation for the test."

The survey was not scientifically rigorous. As reported by the WSJ:

Researchers say that 91% of the 1,231 doctors who responded to their survey “reported believing that physicians order more tests and procedures than needed to protect themselves from malpractice suits.”

The "belief" by a survey respondent that some doctors order tests only to protect themselves is a far cry from admitting that one personally does this.

Another commenter, who identified himself on the WSJ blog as Rod Tucker Esq., wrote:

"Every survey such as this one should require that the doctors give their names and specific examples of the tests they had done which they did not feel were necessary. Then their patients could ask why they were forced to undergo these often harmful and usually painful tests and why they were forced to pay for unnecessary acts by the doctor. The insurance company could also refuse to pay because the test was by definition unnecessary.

No person in business (doctors get paid for their work and are by definition in business) has the right to demand that they get to mess up and not be responsible to the innocent person they hurt. So instead of trying to give doctors a free pass how about we treat them like everyone else and ask the cost of a test and decide for ourselves if it is necessary, just like we do when we buy anything else."

It's important for patients to understand what is going on in the health care industry.  While the powerful medical lobbies often mislead us into believing that it is malpractice lawsuits that are the bane of the health care industry, the truth is, costs related to medical malpractice suits make up a very small amount of the total cost of health care in the United States.