Doctors order too many tests.
That’s not a surprise for regular readers of this site, but even the physicians themselves think so.
A recent survey reported that, “42% of the 627 respondents believed the patients in their own practice were getting too much care. Just 6% of doctors believed their patients were getting too little care … And 28% of the doctors thought they themselves were practicing more aggressively than they would prefer to.”
As to why, the study pointed to an oft-controversial reason: defensive medicine.
The survey, the results of which were published in the latest Archives of Internal Medicine, found 76% of doctors blamed malpractice worries for their over-aggressive care. The impact of defensive medicine has been debated, but “it is certainly the most widely endorsed external factor cited by physicians,” says Brenda Sirovich, an author of the study and a staff physician and research associate in the Outcomes Group at the VA Medical Center in White River Junction, VT.
Sirovich, also an associate professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice, notes that 83% of physicians thought they could easily be sued for failure to order a test that was indicated, but only 21% thought they could be sued for ordering a test that wasn’t indicated.
The incentives point toward “when in doubt, do more,” she says.
That’s true. There is little penalty for over-testing, but the potential for doing too little is harsh. Stories are powerful, like this one from Daniel Merenstein, who failed to order a PSA test and paid the price.
Physician health policy expert Aaron Carroll gives his progressive take on the study, saying that malpractice fears are overblown:
Well, three-quarters of primary care physicians say that concerns about being sued make them practice more aggressively than they’d like. But research shows that physicians in low malpractice risk areas don’t practice much differently than docs in high malpractice risk areas. They also don’t practice much differently after tort reform passes. You’ve heard me talk about how Texas’ malpractice reform didn’t bring spending down much at all.
And he calls physicians who don’t think money influences their decisions “delusional.”
Perception is strong. Despite progressive dogma that downplays the importance of malpractice, that view is clearly not shared by the majority of doctors. Policy experts can cite as many statistics as they want, but in order to convince doctors and sway practice patterns, they have to empathize with physicians’ plight. Taking an antagonistic stance, and calling physicians “delusional” is only going to further the tension between doctors and health policy experts.
Progressive health reformers need doctors to change the health system, despite their inherent distaste for physicians. It would be to their benefit to offer malpractice olive branches and get something back in return, rather than dismissing a problem that the majority of physicians care deeply about.
Kevin Pho is an internal medicine physician and on the Board of Contributors at USA Today. He is founder and editor of KevinMD.com, also on Facebook, Twitter, Google+, and LinkedIn.
