Defensive Medicine

On April 23rd, USA Today had an article on Defensive Medicine by Kevin Pho (a PCP who blogs at KevinMD).

It was a well written piece with a few facts that I thought I would capture here:

  • $2.2T are wasted in our healthcare system (per PWC) due to medical errors, inefficient use of technology, and poorly managed chronic diseases.
  • Defensive medicine was the situation where physicians order tests to avoid the threat of malpractice.
  • Defensive medicine was estimated to contribute $210B annually to this $2.2T in waste.
  • According to the JAMA (2005), 93% of doctors reported practicing defensive medicine.
  • An American Academy of Family Physicians cited a study that physicians who had fought medical liability cases which showed that 90% “suffered significant mental effects from the lawsuits” and 10% contemplated suicide.
  • The New England Journal of Medicine analyzed 1,400 malpractice claims and found that 40% of cases had no medical error.

Kevin goes on to explain that most patients don’t mind the extra tests.  I would argue that patients probably feel that their doctor cares by going the extra mile.

As he talks about, more isn’t always better:

  • Risk of a false positive
  • Radiation from a CT scan might be unnecessary
  • Biopsy can lead to complications

Researchers at the Dartmouth Atlas Project concluded that higher intensity medical services have led to worse outcomes, higher costs, and an increased number of medical errors.

It’s a pretty sad state of affairs.  Physicians afraid of being sued.  Consumers with no direct understanding of the cost.  Again, it gets back to incentives and communication.  We have to align interests and protect people who are doing the right thing.  But, all parties have to be willing and able to provide information and disclose the implications and rationale.

2 Responses to “Defensive Medicine”

  1. About 16% of the adult population strongly DISagree that they “only see physicians for serious illness or injuries.” This 16% generate $500 to $1,500 more claims per person per year than those who agree with the statement. That’s somewhere in the neighborhood of $1.7 billion dollars year in health care spending caused by folks because they have a lower trigger point of when they decide it’s time to go. It angers me that my health insurance premiums are higher because some people are just more willing to seek care.

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