Malpractice concerns put physicians on the defensive

Malpractice concerns put physicians on the defensive

“Worry is interest paid on trouble before it comes due.”  

William Ralph Inge may not have been speaking to the intimidation tactics inherent in medical malpractice, but his words certainly ring true to the sentiment expressed in the latest report from the Center for Studying Health System Change (HSC).

In investigating the Medicare Part A and B claims of approximately 1.9 million patient beneficiaries who were cared for by the 3,469 physicians surveyed from 2007-2009, researchers arrived at a hidden truth: When it comes to possible malpractice liabilities, doctors tend to get spooked.

According to the study findings, Medicare patients who were in the care of a malpractice-fearing physician, on average, received more diagnostic tests and ED referrals. This remained the case regardless of whether malpractice tort reforms had been enacted at the state level.

Mounting malpractice concerns for MDs have ushered in an age of defensive medicine, the study team concluded.

“Traditional malpractice liability reforms don’t appear to resolve the concerns that drive physicians to practice defensive medicine,” said Emily R. Carrier, MD, an HSC senior researcher and coauthor of the study, in a news release. “Dealing with defensive medicine, which not only increases costs but subjects patients to unnecessary care, may require reassuring physicians that medical injuries can be resolved in less adversarial and stressful ways while still protecting patients.”

Researchers ranked the levels of worry within each physician respondent, labeling those with the most malpractice concern "high level" contestants and others without as much fear "low level." Regarding various types of treatment, high level physicians repeatedly out-ordered their lower level counterparts.

All information courtesy of HSC. Presentation by PhysBizTech.

All information courtesy of HSC. Presentation by PhysBizTech.

Senior author of the study, Michelle Mello, professor of law and public health at the Harvard School of Public Health in Boston, told Reuters Health that until physician feelings are considered on the matter, defensive medicine will preservere regardless of tort and legislative safeguards.

"Even with caps or other reform measures, it' doesn't make physicians feel safer," Mello said in the article. "We are finding that the focus should be on how physicians are feeling; that has real implications for future policies."

"Physicians have told me that next to the death of their father, going through a malpractice claim was the worst experience of their life," Mello explained further to Reuters.

With the average physician spending 11 percent of their career “in the shadow of an unresolved malpractice claim,” according to the study authors, it’s time to take more defensive measures against defensive medicine, which accounted for nearly $55.6 billion and 2.4 percent of all U.S. healthcare spending in 2008.

The authors suggested more legal education for docs: “Reducing defensive medicine may require approaches focused on physicians’ perceptions of legal risk and the underlying factors driving those perceptions.”

The study was published in the August 5 edition of Health Affairs.