Guy limps off the tennis court with an obvious sprained ankle. The doctor tells him to go home, elevate the leg and put some ice where it hurts.
Guy says: "Hey, aren't I going to get an X-ray?"
Doctor: "No, you don't need one."
Guy: "I think I ought to have one. I read somewhere ..."
Next thing you know, the physician is ordering an X-ray. That takes five minutes, whereas arguing with the patient would have consumed 15.
Besides, if there's a one-in-a-zillion chance that some exotic disease is causing the ankle pain, the doctor may be at risk of a medical malpractice suit. So the physician does the defensive thing and orders more tests.
Add up millions of little dramas like the above, and you can see how defensive medicine drives up health care costs. One study puts the tab at over $45 billion a year.
By the way, defensive medicine does not necessarily benefit patients. It subjects them to extra tests and procedures, some of them invasive and not without their own risk.
It's been assumed that fear of lawsuits leading to mega-awards pushes doctors to practice defensive medicine and that tort reform will fix the problem. The story is more complicated than that.
Researchers at the Center for Studying Health System Change, Harvard University and the University of Iowa investigated how worry over malpractice suits affects doctors' decisions. Their findings were published in the journal Health Affairs.
The study linked the level of concern expressed by office-based doctors to their Medicare claims for patients treated. It specifically looked at patients visiting a doctor's office with one of three complaints: chest pain, headache or lower back pain. These symptoms can represent a wide range of health problems, from very minor to very serious. So doctors can justify starting modestly in their treatment or throwing the kitchen sink at them after the first visit. …