Patients may ignore "unnecessary" care

More than half of U.S. adults said physicians recommend unnecessary treatments because they are worried about medical liability or want to make more money, according to a Harris Interactive poll.

Fifty-two percent of the 2,286 adults that the research firm surveyed said they chose not to comply with a physician's recommendation regarding a prescription, diagnostic test or surgical procedure because they felt it was too aggressive or unnecessary.

More than 70% of patients said they often or sometimes "experience problems" because of overly aggressive treatments, with 21% of patients saying they got a second opinion and 9% saying they found a new physician for their care.

When asked to speculate why physicians might recommend unnecessary treatments, 53% of those polled said their doctors were concerned about medical liability lawsuits, and 45% said their physicians wanted to make more money.

American Medical Association President J. Edward Hill, MD, said it's not surprising that patients believe medical liability is a driver of defensive medicine.

"Patients pretty much understand that doctors are extra cautious and order a lot of things that if they didn't have this tremendous fear of litigation they might not," said Dr. Hill, a family physician in Tupelo, Miss.

Dr. Hill said he has caught himself practicing defensive medicine and that defensive medicine has driven up medical costs tremendously.

Although a January 2004 Congressional Budget Office study of data from hospitalized Medicare patients failed to find statistically significant spending differences in states with tort reform versus states without it, many other studies have disputed the CBO's finding. For example, an article in the June 1 Journal of the American Medical Association reported that 92% of the 824 Pennsylvania physicians in six high-risk specialties surveyed said they practiced "assurance behavior" such as ordering tests, performing diagnostic procedures and referring patients for consultation when it was clinically unnecessary.

J. Robert Hunter, director of insurance for the Consumer Federation of America, noted that the Harris poll did not ask whether cost or ability to pay was a factor in respondents' decision not to pursue treatment. Otherwise, he said it was unsurprising that patients believe medical liability is such an important factor.

"The anti-lawyer rhetoric is making headway with people," Hunter said. "I would trust [the poll] as telling us what the public thinks, but I would not trust it as meaning anything in terms of telling us what the facts are."

The No. 2 reason poll respondents offered for unnecessary treatments -- physician income -- stems from the realities of modern medicine contributing to that perception.

"There is pressure to increase volume of practice because of reimbursement issues," Dr. Hill said. "You may do a test rather than spend another 15 minutes in interviews" with the patient to possibly discover the problem.

Kevin Pho, MD, a Nashua, N.H., internist and writer of a Web log (link), agreed.

"In the current fee-for-service system, physicians are 'rewarded' for ordering more tests, without regard for performance," he said.

A deeper problem this poll reveals is poor communication between physicians and patients, experts said.

"Communication is key," Dr. Pho said. "In the rushed 15-minute visit in an HMO world, there are certainly cases where communication may not be optimal, and the patient may make a decision refusing a test without fully knowing the risks."

Michael Woods, MD, president and CEO of the consulting firm Doctors in Touch, said 80% of medical liability claims and 60% of patient-safety errors are due to poor communication.

"I find [the poll] to be a sad commentary," he said. "But isn't it a beautiful thing that we can focus on the two biggest problems in health care and kill two birds with one stone just by improving communication?"