Does “defensive medicine” reduce malpractice risks?

In the controversy over defensive medicine and its relationship to medical malpractice claims, studies seems to be done every couple of years that contradict each other. Now yet another study has been released.

What is defensive medicine? The Congressional Office of Technology Assessment (OTA) provided this definition in 1994.

Defensive medicine occurs when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their exposure to malpractice liability. When physicians do extra tests or procedures primarily to reduce malpractice liability, they are practicing positive defensive medicine. When they avoid certain patients or procedures, they are practicing negative defensive medicine.

The analysis claims doctors who practice defensive medicine get sued for malpractice less often. The analysis was done researchers at Harvard and was funded by the National Institutes of Health and the National Institute of Aging.

The researchers investigated whether physicians in seven specialties with higher average hospital charges in a year were less likely to face a malpractice in the following year after treatment of patient.

The analysis in published the The BMJ said

Critics of the US malpractice system often note that it promotes defensive medicine—defined as medical care provided to patients solely to reduce the threat of malpractice liability rather than to further diagnosis or treatment. Physicians report defensive medicine as a major contributor to healthcare costs, and commonly argue that they must practice defensively to reduce malpractice liability.

The report concluded it does reduce the risk of medical malpractice claims, but the conclusion is qualified.

One of the co-authors of the report Seth Seabury, PhD, of the University of Southern California told the MedPage Today website he was surprised by the reduction but cautioned.  “The real takeaway is we need to do more so that the malpractice system as currently construed provides incentives for good quality safe care, but not excessive or wasteful care.”

The study included 24, 637 physicians and  linked to nearly 19 million hospital discharges. The average number of hospital admissions for each physician year varied by specialty and was largest in obstetrics and gynecology and in internal medicine. Malpractice rates varied across specialty consistently with previous studies.

To read the entire analysis Physician spending and subsequent risk of malpractice claims: observational study




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