JAMA defensive medicine study explains why doctors order more tests

Malpractice fears put doctors on defense
“When Geoffrey Blatt went to medical school, he was taught not to order unnecessary tests for his patients. Now, even some patients with headaches get brain scans.

‘You’re afraid of the one-in-10,000 patient that may have a brain tumor,’ the Kansas City neurosurgeon said.

And afraid that the patient may sue for malpractice.

Defensive medicine like this has become standard operating procedure for doctors nationwide.”

Fear of lawsuits alters methods
“According to medical experts, defensive medicine examples include performing breast biopsies in women with lumps unlikely to be cancer, hospitalizing low-risk patients with chest pain, eliminating high-risk procedures and abandoning the practice of medicine altogether.”

Lawsuit fears spark defensive medicine epidemic
“He called the numbers staggering. ‘Perhaps the greatest irony is that defensive medicine may be counterproductive and actually might increase malpractice risk,’ Budetti said . . .

. . . The prevalence of ‘defensive medicine’ is surprising and troubling, said Dr. William Sage, a Columbia University law professor and co-author of both studies.

Sage said the practice is probably widespread, especially in states ‘with unstable malpractice environments.'”

Med-Mal fears have doctors on the defensive, study says
“Dr. Bruce MacLeod, chairman of the department of emergency medicine at Mercy Hospital, said distinguishing between prudent and wasteful medical tests is not always easy. ‘There’s not a bright white line where that is,’ said Dr. MacLeod, who was not involved with the study. What’s more, tort reform should be accompanied by efforts to improve safety for hospitalized patients, he said.

Settlement of malpractice claims for people who have been hurt by medical mistakes rarely offers opportunity for doctors and hospitals to learn from the mistake, Dr. MacLeod said. Settlements are often reached out of court and details are rarely disclosed . . .

. . . Dr. Fred Harchelroad, chairman of the department of emergency medicine at Allegheny General Hospital, said new doctors are often quick to order tests that sometimes may not be needed.

‘They’re taught in medical school that you can’t trust your judgment,’ said Dr. Harchelroad, whose own malpractice premiums doubled three years ago. ‘A test must be ordered.’

Multiple scans and other scans are quickly becoming the new standard of care, Dr. Harchelroad said.”

Doctors’ fear of lawsuits may hurt care – US study
“The most frequent form of defensive medicine, ordering costly imaging studies, seems merely wasteful, but other defensive behaviors may reduce access to care and even pose risks of physical harm . . .

. . . Because both obstetrics and breast cancer detection are high-liability fields, women’s health may be particularly affected.”

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