Defensive Medicine: Can It Increase Your Malpractice Risk?

By Mossman, Douglas | Current Psychiatry, December 2009 | Go to article overview

Defensive Medicine: Can It Increase Your Malpractice Risk?


Mossman, Douglas, Current Psychiatry


In his June 2009 address to the American Medical Association, President Obama commented that "doctors feel like they are constantly looking over their shoulder for fear of lawsuits. Some doctors may feel the need to order more tests and treatments to avoid being legally vulnerable." (1) By practicing what the President called "excessive defensive medicine," doctors provide "more treatment rather than better care" and drive up the cost of health care (Box). (2-7)

[ILLUSTRATION OMITTED]

Box

Adding up the cost of defensive medicine

A 1996 study concluded that Medicare hospital costs for coronary care were 5% to 9% lower in states where effective tort reform has made malpractice suits less lucrative for plaintiffs and lawyers. (2) A recent study estimated that laws limiting malpractice payments lower health care expenditures by up to 4%. (3) Extrapolating these numbers to overall health care costs suggests that defensive medicine generates > $100 billion a year in expenditures. (4)

Defensive medicine has nonmonetary costs as well. In the United States, the rate of additional mammograms after initial screening is twice that in the United Kingdom, although breast cancer detection rates are similar. (5) These differences--which may reflect relative liability fears in the 2 countries (5), (6)--mean that more American than British women receive false-positive biopsies and experience needless anxiety, surgery, scarring, and infection. (6), (7)

This column takes a look at how defensive practices can make psychiatric care more costly and less effective, by answering these questions:

* What is defensive medicine?

* How much medical practice is "defensive," and what does it cost?

* Do psychiatrists practice defensive medicine?

* Does defensive psychiatric practice lead to suboptimal care?

* Are some defensive practices justified?

* Can you balance good defense with good care?

What is defensive medicine?

In a 1994 study, the U.S. Office of Technology Assessment (OTA) said that defensive medicine occurs "when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their exposure to malpractice liability." This definition does not require that defensive clinical practices provide no benefit to patients, only that the expected benefits are small relative to their costs. (8)

Preventing the worst outcome

Studies suggest that doctors develop and maintain practice habits--consciously or not--that aim to reduce their risk of getting sued for malpractice. For example, when patients presenting with tick bites express concern about Lyme disease, doctors overuse tests and needlessly prescribe antibiotics. (9) Although these practices are not evidence-based, they reduce doctors' anxiety by "preventing the worst outcome at relatively little risk and cost and avoiding a potential lawsuit at the same time." (10)

The OTA estimated that up to 8% of diagnostic procedures were ordered primarily because of conscious concern about malpractice liability, based on physicians' responses to a set of written scenarios. (8) In a recent study, 83% of Massachusetts physicians reported practicing defensive medicine and estimated that defensive reasons accounted for why they ordered:

* 18% of lab tests

* up to 30% of procedures and consultations

* 13% of hospitalizations. (11)

Almost all high-liability specialists (such as emergency room physicians, surgeons, and obstetrician/gynecologists) report practicing defensive medicine, often gaging in "assurance behavior"--ordering tests, doing diagnostic procedures, and referring patients to consultants. (12)

Defensive psychiatry

Compared with other specialists, psychiatrists are at lower risk for being sued, but we engage in defensive practices nonetheless. …

The rest of this article is only available to active members of Questia

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Defensive Medicine: Can It Increase Your Malpractice Risk?
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Buy instant access to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    Buy instant access to save your work.

    Already a member? Log in now.

    Oops!

    An unknown error has occurred. Please click the button below to reload the page. If the problem persists, please try again in a little while.