Defensive medicine wastes money and hurts patients

Defensive medicine has always been highly controversial, but there is mounting evidence confirming its major contribution to health care spending.

The Massachusetts Medical Society released a pivotal study today quantifying some of the costs of defensive medicine (via White Coat Notes). For background, I refer you to previous discussions on the issue, as well as last year’s piece on the CBS Evening News that I was involved in.

Defensive medicine can take many forms, with the most common example being unnecessary testing stemming from the fear of being sued.

It can also exhibit more subtle behaviors, such as doctors refusing to perform risky procedures or operations, or limiting their practice for patients at high risk for complications.

Patients are adversely affected by these two defensive medicine phenomena, both by increasing their exposure to complications from procedures and radiation from scans, and decreasing their access to timely medical care.

In a survey of over 900 physicians, here are some eye-opening findings:

* Defensive medicine is conservatively estimated to waste $1.4 billion in Massachusetts

* Over 20 percent of x-rays, CT scans, MRIs, and ultrasounds, 18 percent of laboratory tests, 28 percent of specialty referrals and 13 percent of hospital admissions were ordered for defensive purposes

* Almost 40 percent of doctors limited the number of high-risk services or procedures performed, and 28 percent reduced the number of high-risk patients they saw

This data concurs with a prior high-profile JAMA study which concluded that 93 percent of physicians in high-risk specialties admitted to practicing defensive medicine.

Defensive medicine is real and is a major driver of health care costs. Its effects are indeed difficult to quantify, but the JAMA and MMS studies are providing concrete numbers, which I suspect upcoming studies will validate.

Any health reform initiative that does not address defensive medicine is leaving a significant amount of fiscal savings on the table, and will continue to make patients vulnerable to tests and procedures borne out of malpractice fears.

topics: defensive medicine, malpractice

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