Defensive Medicine: A Culprit in Spiking Healthcare Costs

By Segal, Jeffrey | Medical Economics, May 25, 2012 | Go to article overview

Defensive Medicine: A Culprit in Spiking Healthcare Costs


Segal, Jeffrey, Medical Economics


Blood work, biopsies, magnetic resonance imaging (MRI), computed tomography (CT) scans, stress tests, electrocardiograms (EKG), and sonograms. Eighty-two percent of physicians order more tests and procedures than are medically necessary-and almost on a daily basis- in fear of potential lawsuits.

According to a 2010 poll conducted by the Gallup organization, about $1 in every $4 spent in healthcare can be attributed to tests and procedures that are clinically unnecessary. The problem has become so overwhelming that in April, a group of nine medical specialty societies, including the American Academy of Family Physicians and the American College of Physicians, launched the Choosing Wisely initiative. Led by the American Board of Internal Medicine Foundation, the initiative asks doctors to cut back on 45 tests and procedures that provide little value to patients. (See www.MedicalEconomics.com/choosingwisely for more information.)

TORT SYSTEM MUST CHANGE

The medical profession is to be commended for drawing attention to exuberant testing. But although the profession is starting to increase awareness about defensive medicine, it might not change the behavior of physicians until we change our medical tort system. As some doctors have told me, they have no choice but to "scan some patients until they glow" as long as they possibly can be hauled into court for frivolous reasons.

In most cases, physicians order up tests not because they were necessary to diagnose what was wrong, but because if they didn't and something went very wrong, they believe they would not be protected in a lawsuit.

Patients for Fair Compensation, a nonprofit organization seeking to educate policymakers about defensive medicine, estimates that unnecessary tests and procedures cost about $650 billion a year. (Full disclosure: I am a board member of this group.) That is money spent on the unnecessary MRI the doctor ordered for a worker with a nagging backache, for example, and the EKG the physician ordered on an otherwise healthy 36-year-old patient with no history of heart disease.

The $650 billion in lost revenue spent on unnecessary tests includes money coming out of the pockets of taxpayers. Medicare pays up to $125 million a year for unnecessary tests and procedures, and Medicaid pays up to $96 billion for unneeded tests and procedures.

A brief list of what many patients can do without:

* CT scans after uncomplicated fainting episodes;

* stress tests with routine physicals absent cardiac symptoms or a family history of heart disease;

* chest x-rays for patients undergoing routine outpatient surgeries when accompanied by normal physical exams;

* antibiotics for routine sinusitis; and

* osteoporosis screening for women aged fewer than 65 years.

Doctors often feel compelled to order these tests or treatments because patients demand it In today's world, patients expect quick remedies for their symptoms. When they don't get immediate relief, they push physicians to use the latest technologies to discover what's wrong. It's the American way.

As long as a doctor believes he or she could be the potential target of a frivolous lawsuit, he or she will keep ordering tests and procedures. …

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