Defensive medicine to avoid liability lawsuits is widespread

Whether a physician practices in a surgical or nonsurgical specialty, lives in New England or the Mountain states, one thing is the same: The vast majority of doctors practice defensive medicine to protect themselves from medical liability lawsuits.

About nine in 10 physicians said doctors order more tests and procedures than patients need so they can protect themselves against lawsuits, according to a study in the June 28 Archives of Internal Medicine.

The only statistically significant difference was among men and women: Nearly 93% of male physicians agreed that doctors order more tests. Nearly 87% of females believed that to be true.

And 91% of the 1,231 physicians surveyed nationwide agreed that doctors will not stop using unnecessary diagnostic tests without protections against unwarranted lawsuits.

"The general sentiment is that there is a problem," said internist and study co-author Tara Bishop, MD, associate in general internal medicine at Mount Sinai School of Medicine in New York City. "Many physicians feel they are vulnerable to malpractice lawsuits even when they practice competently within the standard of care."

The study notes that the cost of defensive medicine is estimated to be $60 billion annually.

"Even if the true cost of defensive practices was only a fraction of this amount, it would still represent a significant source of cost savings," study authors concluded. They are calling for policymakers to "consider reforms that curb defensive medical practices as they work to identify strategies to reduce health care spending and promote efficient, high-quality health care."

In a commentary accompanying the study, Sen. Orrin G. Hatch (R, Utah) wrote that he and several colleagues have tried to address the costs of defensive medicine but have met opposition.

"These proposals have taken a variety of forms, including caps on noneconomic damages ... limitations on joint and several liability, and heightened evidentiary standards for punitive damages ... Unfortunately, trial lawyers associations have successfully blocked tort reform, arguing that people with low incomes will not be able to find trial lawyers to take their cases on contingency if settlements are capped."

Hatch said he hopes that Americans "will demand in larger numbers that real reforms be enacted to address this problem."