Eagerly awaiting the death of defensive medicine

I’ve always been annoyed by proponents and defenders of defensive medicine, i.e., doctors ordering unnecessary tests to stave off lawsuits. Not always, but often enough, it is a case of physicians shirking responsibility, blaming others, and acting in a self-serving manner. Attitudes haven’t changed that much, if Defensive medicine: A solvable problem in Healthcare Finance News is to be believed.

A Medscape survey cited in the article asked physicians who’s been sued to give advice to others:

Among the remarks: “Document more often, more thoroughly… get rid of rude, demanding, noncompliant patients… practice more defensive medicine.” One advisor went so far as saying: “Don’t assume ANYTHING!! If it hurts, CAT scan it. If it hurts between the nose and the toes, consider it a heart attack and stress-test everyone from 9 to 90!”

A 2010 survey of physicians found that doctors thought 26 percent of health care costs were due to defensive medicine.

Although there may be a knee-jerk reaction to test more rather than less, there’s no evidence that the amount of testing has anything to do with the likelihood of a lawsuit. In a fee-for-service environment, more testing puts more money in the doctor’s pocket, so I’ve always been skeptical of the “defensive medicine” explanation for over-testing.

Now that capitation in various guises is coming into vogue, physicians and hospitals are going to look at things a little differently. I’ll bet the same doctor who recommends indiscriminate scans and stress tests today will find some other approach to risk management once financial incentives are re-aligned. With a bit of luck, that will sound the death knell of defensive medicine.

Thankfully there are other approaches to protecting against lawsuits, including not making errors in the first place and apologizing when mistakes do occur. I’m sympathetic to physicians who get sued, but we shouldn’t make too much of their defensive medicine advice.

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By David E. Williams of the Health Business Group.

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