Don’t Sue Me Bro

You walk into your doctor’s office with a headache. Like most people, before you made the appointment you did a quick Google search with your symptoms, and are now convinced you have a brain tumor—a meningioma maybe. WebMD says that meningiomas can be fatal, so you call your mom to let her know you love her but she ought to mentally prepare herself for the inevitable. Though your doctor knows that patients with headaches with no other symptoms have a less than 1% chance of having a brain tumor of any kind, he or she orders an MRI. This expensive study is unlikely to yield a diagnosis, but an unnecessary test today keeps the lawyer away.

Source: Flickr/CC

Defensive medicine is estimated to cost $46 billion annually in the US. It seems intuitive that physicians with a greater fear of litigation would order greater numbers of tests and scans, leading to greater cost of health care. If this is true, implementing tort reform could lead to a decrease in defensive medicine and a subsequent decrease in costs.

A study published this year in the Journal of the American Medical Association looked at 36 internal medicine doctors at three hospital services in Massachusetts to determine if they were ordering tests solely to prevent future legal liability. First, the doctors completed a survey on their attitudes toward defensive medicine. After the survey, they reviewed the laboratory tests, CT scans, and hospital admissions they ordered on the previous day and indicated which were placed because of concern for malpractice liability.

The researchers examined whether physicians that were concerned about being target by litigation would practice more defensively and have higher costs. They found that 28% of the tests, scans, and admissions were at least partially defensive, correlating to 13% of costs. Most of the increased costs were due to unnecessary hospitalization. However, physicians who practiced defensive medicine the most actually seemed to spend less than those who didn’t label their orders as defensive, showing the complexity in the relationship between defensive medicine and increased health care costs.

The small sample size and one day order assessment make this study insufficient to make any real claims about defensive medicine, leaving policymakers uninterested in tort reform with much left to be desired. Though I doubt the researchers were expecting a one-to-one relationship between defensiveness and costs, it is surprising that there was no strong correlation with costs at all. Until further studies can flesh out the potential savings from tort reform (whether in cost or physician headache), states without it are likely to remain unmotivated.

commentary by Regina Bailey, MD, JD, LLM and Farah Kudrath, MPH

Abstract

The overuse of tests and procedures because of fear of malpractice litigation, known as defensive medicine, is estimated to cost $46 billion annually in the United States, but these costs have been measured only indirectly. We estimated the cost of defensive medicine on 3 hospital medicine services in a health system by having physicians assess the defensiveness of their own orders. We hypothesized that physicians who were concerned about being targeted by litigation would practice more defensively and have higher overall costs. PMID: 25222939

Rothberg et al. JAMA Intern Med. 2014; 174(11): 1867-1868.