Nav: Home

Does defensive medicine work?

November 04, 2015

Higher-spending physicians face fewer malpractice claims, a study led by researchers at Harvard Medical School has found.

Nearly three-quarters of physicians report practicing defensive medicine, which is broadly defined as the ordering of tests, procedures, physician consultations and other medical services solely to reduce risk of malpractice claims. Defensive medicine is estimated to cost the U.S. as much as $50 billion annually.

Despite its ubiquity among physicians, whether or not higher spending by physicians actually reduces malpractice claims is unknown. One view is that better communication and early apologies for errors can reduce a physician's liability. However, greater spending by physicians could also either reduce errors or signal to patients, attorneys and courts that despite an error, a physician was exhaustive in his or her care.

The research was led by Anupam Jena, associate professor of health care policy at Harvard Medical School and an internist at Massachusetts General Hospital. The findings, published in the BMJ, combined data on 18,352,391 hospital admissions in Florida during 2000-2009 with data on the malpractice histories of the 24,637 physicians who treated patients during those hospitalizations. Overall, 4,342 malpractice claims were filed against physicians (2.8 percent per physician-year), with malpractice claims rates ranging from 1.6 percent per physician-year in pediatrics to 4.1 percent per physician-year in general surgery and obstetrics and gynecology.

Jena and colleagues at the Leonard D. Schaeffer Center for Health Policy and Economics at the University of Southern California and at Stanford University found that in six out of seven specialties, higher-spending physicians faced fewer malpractice claims, accounting for differences in patient case-mix across physicians.

For example, among internal medicine physicians, those in the bottom 20 percent of hospital spending (approximately $19,000 per hospitalization) faced a 1.5 percent probability of being involved in an alleged malpractice incident the following year, compared to 0.3 percent in the top spending quintile (approximately $39,000 per hospital admission).

Similar findings were seen in C-section rates among obstetricians. High C-section rates are commonly considered a signal of defensive practice, and obstetricians who performed relatively more C-sections were less likely to face a malpractice claim.

"It has remarkably been unknown whether defensive medicine 'works' or whether the majority of U.S. physicians could be incorrect in believing that greater spending is associated with reducing malpractice liability," said Jena.

Prior work by Jena and co-author Seth Seabury, a Fellow at the Schaeffer Center and associate professor of clinical emergency medicine at the Keck School of Medicine at USC, has found that the typical physician spends nearly 11 percent of their career with an open malpractice claim and that in high-risk specialties, the lifetime risk of being sued is nearly 100 percent.

"The threat of malpractice is a very salient risk for most practicing physicians, particularly in high-risk specialties," Seabury said. "If physicians perceive that higher spending can protect them from malpractice claims, then they are likely to practice defensively even if they feel that the additional spending is unnecessary or offers no clinical benefits to patients."

An important limitation of the study is that it could not conclude exactly why greater spending by physicians was associated with fewer malpractice claims. Moreover, whether higher levels of spending were defensively motivated by malpractice concerns is still unknown.

"Although not conclusive, our study provides initial evidence on why efforts to reduce health care spending among physicians may meet sluggish opposition. Physicians may perceive a potential tradeoff between lowering spending and increasing risk of malpractice," Jena said. "Broader health care reform efforts should recognize the role that physician perceptions about malpractice play in resource utilization decisions."
-end-
The study was funded by an Early Independence Award 1DP50D017897-01 from the National Institutes of Health.

Harvard Medical School has more than 7,500 full-time faculty working in 10 academic departments located at the School's Boston campus or in hospital-based clinical departments at 15 Harvard-affiliated teaching hospitals and research institutes: Beth Israel Deaconess Medical Center, Boston Children's Hospital, Brigham and Women's Hospital, Cambridge Health Alliance, Dana-Farber Cancer Institute, Harvard Pilgrim Health Care Institute, Hebrew SeniorLife, Joslin Diabetes Center, Judge Baker Children's Center, Mass. Eye and Ear/Schepens Eye Research Institute, Massachusetts General Hospital, McLean Hospital, Mount Auburn Hospital, Spaulding Rehabilitation Hospital and VA Boston Healthcare System.

Harvard Medical School

Related Malpractice Articles:

Paid medical malpractice claims decrease
Researchers report that the overall rate of claims paid on behalf of all physicians dropped by 55.7 percent.
Use of patient complaints to identify surgeons with increased risk for postoperative complications
Patients whose surgeons had a history of higher numbers of patient complaints had an increased risk of surgical and medical complications, according to a study published online by JAMA Surgery.
Patient complaints can identify surgeons with higher rates of bad surgical outcomes
Recording and analyzing patient and family reports about rude and disrespectful behavior can identify surgeons with higher rates of surgical site infections and other avoidable adverse outcomes, according to a study led by Vanderbilt University Medical Center (VUMC) investigators in collaboration with six other major academic health systems.
Study finds state tort reforms linked to decreases in radiography utilization
According to new research from the Harvey L. Neiman Health Policy Institute, state tort reform has been associated with a decrease in physician ordering of radiographs.
Hospitals can tear down 'wall of silence' using new research-based patient safety toolkit
A new toolkit for hospitals aims to break down the 'wall of silence' that often rises after something goes wrong in a patient's care.
More Malpractice News and Malpractice Current Events

Best Science Podcasts 2019

We have hand picked the best science podcasts for 2019. Sit back and enjoy new science podcasts updated daily from your favorite science news services and scientists.
Now Playing: TED Radio Hour

Anthropomorphic
Do animals grieve? Do they have language or consciousness? For a long time, scientists resisted the urge to look for human qualities in animals. This hour, TED speakers explore how that is changing. Guests include biological anthropologist Barbara King, dolphin researcher Denise Herzing, primatologist Frans de Waal, and ecologist Carl Safina.
Now Playing: Science for the People

#534 Bacteria are Coming for Your OJ
What makes breakfast, breakfast? Well, according to every movie and TV show we've ever seen, a big glass of orange juice is basically required. But our morning grapefruit might be in danger. Why? Citrus greening, a bacteria carried by a bug, has infected 90% of the citrus groves in Florida. It's coming for your OJ. We'll talk with University of Maryland plant virologist Anne Simon about ways to stop the citrus killer, and with science writer and journalist Maryn McKenna about why throwing antibiotics at the problem is probably not the solution. Related links: A Review of the Citrus Greening...