Defensive Medicine is a Fraud.

Defensive medicine is the name doctors give to the tests or treatment they admit are unnecessary but they order anyway out of what they claim is fear of being sued for malpractice.  It is an unethical fraud and the doctors who claim to be driven by fear of being sued are lying to themselves as well as to the public.

Gary Ross on Twitter: "The cost of defensive medicine… "

The concept of defensive medicine arose in the 1970’s when the number of medical malpractice suits began to rise precipitously.  As malpractice insurance premiums began to rise, often for reasons having little to do with successful malpractice suits, medical practitioners panicked.  The sky was falling.  In order to reduce the likelihood of being sued, they began to order pretty much every conceivable test.  Times have changed.  Despite the fact that the number of malpractice suits has been dropping for decades, doctors continue to practice defensive medicine at high rates.

The ordering of every conceivable test has had unintended consequences.  In the first place, when it was rare to order every conceivable test, doctors could legitimately claim that the standard of care did not require all of these tests be ordered.  A breach of the standard of care is what a patient must prove to be successful in a malpractice case.  The standard of care, which is almost never in writing, is what a reasonable and prudent health care provider in the same specialty would do under the same or similar circumstances.  After nearly 50 years of ordering every conceivable test, that practice has now become the standard of care.  Doctors have trapped themselves.  They know what they are doing is of little or no benefit to their patients but they just can’t stop.

Another unintended consequence is that ordering every conceivable test harms patients.  Not only does it burden the health care system and their patients with unnecessary bills and charges, it puts patient health at risk.  Even the most carefully performed test exposes the patient to some risk.  A blood draw opens the door to infection.  An x-ray increases the risk of excessive radiation exposure.

Additionally, every test creates the risk of a mistaken interpretation.  The chest x-ray may show a cancer that goes unnoticed.  A blood test may show an alarming increase in an enzyme indicating the presence of disease that is overlooked by the doctor.  The most common allegation of malpractice is the missed diagnosis.  The more tests that are performed, the more likely it is that something will show up and be missed and that the doctor will be sued for missing the diagnosis.

Of course, not all test results are conclusive.  That density on the chest x-ray may be cancer or it may just be a shadow caused by the way the patient was positioned.  We can’t be too careful so now we have to do follow up studies and may even have to do a biopsy.  More risk to the patient.

Even when the test result is clear, it can be wrong.  It may be a false negative, which may expose the doctor to liability for a missed diagnosis.  Alternatively, the test may come back with a false positive, as many do.  This means that our patient, who is healthy, now ends up being treated for the disease the unnecessary test incorrectly said she has.   It is never good to be treated for a disease you don’t have.  Unfortunately, unnecessary treatment is a common result of the practice of defensive medicine.

As noted above, the risk of suit has been declining for decades but the use of defensive medicine persists and persists at high levels.  A survey found that 77% percent of doctors reported that they would stop practicing defensive medicine, if only they were given protection against malpractice suits.  This response shows that doctors are misleading themselves about defensive medicine.  A number of states have given substantial protections to doctors to either reduce the number of malpractice suits or to limit damages that patients can recover.  Studies have shown no substantial reduction in the practice of defensive medicine in those states.

It is also important to remember that those increased billings due to defensive medicine are being paid to doctors, hospitals and laboratories.  Many labs are owned by doctors.  Stopping defensive medicine would reduce the income of the doctors who practice it.  The more defensive medicine they practice, the greater the income loss would be were defensive medicine to go away.  Understandably, it is easier to blame lawyers and malpractice suits for defensive medicine than it is to admit that you have been fleecing the public all along.

Doctors, who profess to live by the Hippocratic promise to “first do no harm,” should look at the harm to their patients caused by their practice of defensive medicine and give it up.  On the other hand, it is easier and more profitable to just keep claiming that defensive medicine is all the fault of the lawyers and the legal system.  Doctors are not likely to give up defensive medicine without a fight.

Posted in Cancer, Defensive Medicine, Doctors, Fee for Service, Fraud, health, Health Care Costs, Health Insurers, Hospitals, Infection, Lawsuits, Malpractice caps, Medical Costs, medical ethics, Medical Malpractice, Misdiagnosis, tort reform |