Introduction

Reviews

Avoiding Defensive Medicine

Timothy B. McCall, M.D.

When a doctor says let's get this test “just in case,” it often means the likelihood of your having the problem is minuscule. Before agreeing to go along, particularly if the test is invasive, find out how likely the problem is. Ask: Would it be risky if I didn’t have the test right away? Could I come back if my symptoms persist?

“Just in case” can be a tip-off to defensive medicine, as in, “I’d like to get this test just in case you decide to sue me later.” Defensive medicine refers to any action by a physician designed to reduce the risk of being sued for malpractice. Doctors these days are, not completely without justification, paranoid about malpractice suits. In a climate of multi-million dollar awards to plaintiffs and skyrocketing malpractice insurance premiums, many physicians have changed the way they practice medicine. Some of these changes may be to your benefit, as when the doctor is more thorough or explains the side effects of treatments better. But not all the changes are desirable.

Researchers from Harvard University surveyed physicians about their attitudes about getting sued and whether they had made any changes in how they practiced medicine in response. They found that doctors greatly overestimate their odds of being sued for malpractice: On average, doctors perceived they had about a one in five likelihood of being sued in a given year, about three times the actual rate. The doctors estimated that if they were negligent and the patient was harmed as a result, they’d get sued 60% of the time. In fact, the researchers discovered that less than 2% of such negligent events lead to a malpractice suit. The doctor’s estimates were 30 times too high. In response to their fear of malpractice suits, four out of five doctors admitted ordering additional tests and procedures.

When doctors order tests they know aren’t necessary to lower their risk of lawsuits, their patients may be subjected to potentially dangerous tests and may worry needlessly that they have the medical condition being looked for. Medical costs go up, too. According to the AMA, the cost of defensive medicine in the United States is 20 billion dollars annually and is rising.

The funny thing is that these efforts by doctors to protect themselves from lawsuits probably don’t work. For the most part, patients sue doctors they don’t like. If a patient finds a doctor arrogant, withdrawn or unconcerned and then something goes wrong, the result may be a lawsuit. But if the relationship is good, lawsuits seldom result.

Next: Avoiding Unnecessary Routine Tests

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