A study shows defensive medicine may reduce medical liability. Why was it ignored?


Did you hear about that recent, groundbreaking study on defensive medicine?  Probably not.  The sites where I regularly read health policy news — Vox, the Incidental Economist, and the Upshot, for instance — all failed to mention it.  (Correct me if I’m wrong.)

Published in the British Medical Journal, researchers found that doctors who charged more, presumably by ordering more tests, were sued less often: “In six … specialties, a greater use of resources was associated with statistically significantly lower subsequent rates of alleged malpractice incidents.”

According to the accompanying editorial, “the study is the first to substantiate a common assumption that if doctors spend more and use more resources, they are less likely to be sued.”

It’s no secret that many physicians perceive that defensive medicine protects them from liability.  Depending of which study you read, between 70 and 90 percent of physicians admit to practicing defensive medicine.  (That contrasts to 48 percent of government physicians, who, perhaps not coincidentally, are protected from medical liability.)

Health reformers generally dismiss physicians’ concerns when it comes to defensive medicine and downplay (or, in this case, ignore) studies that legitimize the phenomenon.  Instead of acknowledging defensive medicine, many propose improving communication between doctors and patients to reduce liability.   While there’s no denying that this should be done regardless, the burden is often placed on individual physicians without acknowledging that system-wide changes are needed as well.

Another reason?  Political, of course.

Health reformers and policy wonks generally skew progressive, and liability reform doesn’t fit those who view the our health system through a left-leaning lens.  But perhaps it’s time to remove the glasses and take defensive medicine seriously.  Even at the expense of progressive dogma.

If health reformers truly want to cut back on unnecessary health spending and transition to quality-based payments, they need to get physicians on board. The best way to do so is to hold their nose, give doctors the olive branch of liability reform, and offer serious solutions to address the issue.

Kevin Pho is an internal medicine physician and co-author of Establishing, Managing, and Protecting Your Online Reputation: A Social Media Guide for Physicians and Medical Practices. He is on the editorial board of contributors, USA Today, and is founder and editor, KevinMD.com, also on FacebookTwitterGoogle+, and LinkedIn.

Image credit: Shutterstock.com


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