Many physicians privately admit to practicing what they call “defensive medicine.” They order tests or perform procedures they do not believe the patient really needs but justify doing so on the grounds that it may keep them from being sued for medical malpractice. To say that there are a couple of problems with this practice is to engage in understatement. In the first place, it is unethical for doctors to order tests or perform procedures the patient doesn’t really need. It is even worse to do so for the benefit of the ordering doctor. The purpose of ordering a test or performing a procedure is to help the patient. Any other consideration is superfluous. Second, doctors get paid for ordering and interpreting unnecessary tests or performing unnecessary procedures so they have a double financial motive. In addition, tests are often performed at facilities in which the doctor has some financial interest, so the doctor makes even more money on unnecessary testing, which they insist is all the fault of the justice system. Lastly, many studies have shown that practicing what the doctors call “defensive medicine” does not lead to fewer malpractice suits. This may be due to the fact that the unnecessary tests and procedures are not being done to avoid malpractice but for the financial benefit of the ordering doctor.
Last month an article appeared in The BMJ which reported on the relationship between doctor spending on patient care during hospitalization and the risk of being sued in the following year. The authors studied data from nearly 19 million hospitalizations in Florida between 2000 and 2009. They found that across all specialties the doctors who ordered the most costly care for their patients had a lower risk of being sued in the year following the hospitalizations. The authors did not break the data down by individual patients. Since the study was observational only, the authors caution that no definite conclusions can be drawn from the data. For example, they were not able to tell whether the more expensive care was driven by more serious illness or whether the more expensive care was defensively motivated or not.
In spite of the limitations of the study, it is likely to add more fuel to the debate over “defensive medicine.” Those who justify ordering unnecessary tests and performing unnecessary medical procedures as “defensive medicine” will point to the study as justifying their claim that to do so protects them from subsequent malpractice suits. Those who believe that patients should receive and pay for only medically necessary care will point to the weaknesses in the study and the lack of information about the motivation for the increased spending.
