The Practice Of Defensive Medicine

Defensive medicine, also called defensive medical decision making, refers to the practice of recommending a diagnostic test or treatment that is not necessarily the best option for the patient, but acts as a safety net to protect the physician against the patient as potential plaintiff in a medical malpractice lawsuit.

Impact Of Defensive Medicine 

Cost estimates to the U.S. healthcare system for procedures used in defensive medicine range from anywhere between $46 billion and $850 billion; this wide variance indicates that the effect that defensive medicine practices have on patient outcomes is notoriously challenging to quantify.

The Cunningham Group’s internet TV Program, Healthcare Matters, explores the intersection of healthcare practice, the business of medicine and the law. In their latest installment, The State of Defensive Medicine,  featuring Richard E. Anderson, MD, FACP, Chairman and CEO of The Doctors Company, new and interesting insights into defensive medicine and how it permeates the healthcare system were discussed in detail.

Dr. Anderson’s definition of defensive medicine as “…a test, procedure or therapy that is ordered by the physician primarily to protect himself or herself from liability rather than because of its diagnostic or therapeutic utility,” really only scratches the surface in understanding defensive medicine; it is far from completely defining the concept. In order to further dive into the effects of defensive medicine, we should examine what physicians themselves have to say about whether or not they do it, and why or why not.

Patient Outcomes & Medical Lawsuits 

In today’s ever-changing healthcare system, physicians have many reasons to be worried about patient care, and whether a bad outcome could lead to a lawsuit.

Surveys have shown that defensive medicine is being practiced at all levels in every specialty.

• 73% of all physicians admit to practicing
• 93% of all specialists admit to practicing
• 45% of medical students and residents said that they were taught to practice defensive medicine in medical school or residency programs

Why is the practice of defensive medicine so common?

In a survey of general practitioners, reasons as to why a provider would even practice defensive medicine began to emerge. Since when did the goal shift from providing optimal healthcare to the patients, to protect the institution at all costs? Here are the findings.

• (76%) said malpractice concerns
• (52%) said it was to meet clinical outcomes
• (40%) said they had too little time to spend with patients

Malpractice lawsuits have a huge impact on all physicians. Specialist, such as surgeons and OBGYNs are involved in high-risk procedures, and may be more likely to face malpractice lawsuits. When surveyed, more than 69% of neurosurgeons said that they viewed every patient as a potential lawsuit. As a result of the current risk of medical liability malpractice lawsuits, 45% of  neurosurgeons have decided to just stop doing high-risk procedures entirely.

Ridding the system of defensive medicine

Defensive medicine will not just go away and there is no easy answer. Though certain factors have led to its widespread adoption among providers, the first step in dissolving the practice of defensive medicine is to get a deeper understanding of the scope and depth of the problem.

Find out more about The Effects of Liability Rules on Medical Practice and how defensive medicine leads to nonoptimal health care decisions here.