Reasons why doctors practice defensive medicine

Here’s a simple chart that sums it all up. Apologies for the small type.

Reasons why doctors practice defensive medicine

As The Happy Hospitalist writes, “Some doctors and patients may be willing to experience some anxiety for the unknown. But most won’t, especially since neither party is directly paying for the testing. This selfish interest is rooted in moral hazard, at the expense of national economic security.”

And the bottom line today practice climate is, for doctors, always be in the top row.

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  • http://drbrenner.blogspot.com irb123

    Cool chart. Yes doctor anxiety coupled with patient anxiety and expectations do lead to a significant amount of defensive medicine. And if you check this out, you’ll see why tort reform won’t suddenly make those concerns you bring up go away: http://drbrenner.blogspot.com/2009/08/risks-of-defensive-medicine-and-why-it.html

  • Julio

    The truth is this chart does not sum it all up. Some tests have inherent risks, sometimes bigger than that which you want to prevent. So you could have this additional outcome:
    TEST x BAD OUTCOME (due to test):
    Patient: “Why ever did you order this test if it wasn’t necessary?”
    Doctor: “I guess I was overzealous.”
    Lawyer: “I take half.”
    Insurance: “We need more money.”
    Government: “We need more money.”

  • SarahW

    Thanks, Julio. And the lawyer deserves his half, or his 30 percent, or his discounted fee.

  • Susan H

    I wonder if those who decide what other people ‘deserve’ factor risk-taking into the equation.
    The legal profession has scant risk of its victims’ recourse for mistakes, no risk of predatory (greenmail) litigation, no risk of bodily injury in the course of doing business, scant risk of government price-fixing for professional services….

    Of what professions are the critics, I wonder, who criticize the doctors, nurses, soldiers, police,firefighters…

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  • http://www.wireriskstrategies.com Kathy Wire

    While I sympathize with physicians on this issue, there are two things I think they have to own. (I have worked in risk management with doctors in many different environments over many years.)

    1. It is easier and faster to do the test, give the treatment,etc., and so it therefore represented the simple road, especially if the patient isn’t paying. So they chose the easy road, and have developed defensive medicine arguments in part as a justification for that.

    2. I can’t tell you how often I heard physicains reject any effort to establish guidelines, pathways, or any other incorporation of clinical effectiveness research. It was “cookbook medicine” or some such and therefore represented an intrusion into their freedom to practice. And they were afraid, for reasons I will never understand, that the protocols would work against them. When I explained that evidence-based protocols, when followed, could only help justify their choices, they refused to hear my words. I believe they wanted to be free to do whatever they wanted without having to justify any deviance from the evidence-based practice.

    I wonder how different our scene might be today had the medical community embraced clinical effectiveness as the primary standard of practice twenty years ago? And viewed it as their best defense against malpractice?

  • http://www.shragerlaw.com/blog/ Rob Sachs

    What we’re really talking about is who bears the cost of medical certainty? What is the benefit of so-called “defensive medicine?” For the patient, the extra test will tell you if you do or don’t have a serious condition. For the doctor, there’s medical certainty that you’ve properly diagnosed the patient…read: done no harm. Isn’t that what it’s supposed to be about? The Hippocratic oath is to “do no harm.” If you’ve found the best answer that modern science can offer, isn’t that really doing no harm?

    This debate is all about how the issue is framed. The opponents of health care insurance reform are using this as a chance to limit lawsuits. Maybe instead of talking about “defensive medicine” the proper label for this cost in our health care system is the cost of medical certainty. We should re-focus our debate on how much we as a society are willing to pay for proper and timely diagnosis – using the technology available to us in the US – rather than trying to make those already hurt by medical negligence bear the further cost of not having an adequate remedy in court.