Physicians Practicing Defensive Medicine to Avoid Malpractice
Defensive medicine is a style practiced by doctors who alter their clinical behavior in an effort to shield themselves from lawsuits. The purpose is to reduce negative consequences of medical treatment, discourage patients from filing malpractice claims, or convince the legal system that the standard of care was met. Although doctors must buy expensive malpractice insurance to protect themselves, many are not confident that the policy will cover them fully.
Nowhere in the country is the malpractice environment as unstable as it is in Pennsylvania. After several insurance companies stopped writing policies leading to skyrocketing malpractice insurance premiums, high numbers of physicians moved or quit their practices.
Until now, research to learn how often doctors alter their behavior due to the threat of malpractice lawsuits has focused on a single medical specialty or on doctors at low risk of lawsuits. Investigators seeking to build upon previous research on defensive medicine have studied its prevalence and characteristics among physicians practicing in several high-risk specialties in Pennsylvania. Their results are published in the June 1, 2005 edition of the Journal of the American Medical Association .
About the Study
In 2003, researchers from Harvard School of Public Health and the Columbia Law School collaborated with a professional survey organization to conduct a mail survey of 824 physicians in Pennsylvania. The physicians practiced in one of six specialties affected by high and rising malpractice liability costs: emergency medicine, general surgery, neurosurgery, obstetrics/gynecology, orthopedic surgery, and radiology.
The questionnaire asked respondents to rate how frequently their concerns about liability caused them to engage in either assurance behavior, by supplying additional services, or avoidance behavior , by distancing themselves from risk. In some cases, doctors were asked to describe their most recent acts of defensive medicine. They were also asked whether they had, or were planning to, reduce or eliminate the high-risk aspects of their practice.
More than nine out of ten survey respondents reported that they practiced some form of defensive medicine, a much higher percentage than previously reported.
Doctors reporting assurance behavior ordered tests, referred patients, prescribed medication, and suggested procedures; all of which they considered medically unnecessary. Ordering excessive imaging studies was the most common defensive act. Those reporting avoidance behavior changed their practices to avoid high-risk procedures and patients they thought might sue them.
These results indicate that women may be more adversely affected by the consequences of defensive medicine than men, since both obstetrics and breast cancer treatment are high-liability fields.
While the study is a valuable addition to the body of research on defensive medicine, it is not without its limitations. The reliability of physicians to gauge their own defensive practices is not well known. Also, the study is specific to only six medical specialties in a state with one of the highest malpractice insurance rates.
How Does This Affect You?
In the end, the practice of defensive medicine is not in the best interest of patients. It not only raises the cost of health care on the whole, but it can limit access to quality care, and even cause physical harm.
An independent initiative in Pennsylvania called The Project on Medical Liability is looking at ways to reduce the negative consequences of defensive medicine on individuals. It is currently conducting a demonstration project to explore whether mediation, apology, and good communication about medical errors could be an effective approach to avoiding lawsuits. There is already substantial evidence that the quality of the patient-doctor relationship is a better predictor of lawsuits than bad outcomes from medical errors.
According to the researchers of this study, one way to reduce defensive medicine is to educate patients and physicians about appropriate care in situations that are commonly associated with high liability. Educating yourself about your condition, and developing trusting relationships with doctors you can communicate with are measures you can take to prevent defensive medicine from affecting your health care.
The Project on Medical Liability in Pennsylvania (funded by the Pew Charitable Trusts)
Medical Liability Reform
American Medical Association
Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA . 2005; 293 (21):2609-17.
Editorial: Practice of defensive medicine widespread among physicians in specialties at high risk of lawsuits. JAMA . 2005; 293 (21).
Medical Error Disclosure, Mediation Skills, and Malpractice Litigation: A Demonstration Project in Pennsylvania; March 2005.
Last reviewed Jun 2, 2005 by ]]>Richard Glickman-Simon, MD]]>
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