9 In 10 Docs Blame Lawsuit Fears For Overtesting

CHICAGO — Ninety percent of physicians surveyed said doctors overtest and overtreat to protect themselves from malpractice lawsuits.

That sentiment is more common among male doctors than female doctors, according to the survey published Monday in Archives of Internal Medicine. The findings echo a recent Associated Press story in which many emergency room doctors said lawsuit fears are the main reason for overtreating in the ER.

The Archives survey of 1,231 physicians nationwide included ER doctors and other specialists, surgeons and primary care doctors.

The survey asked two questions: "Do physicians order more tests and procedures than patients need to protect themselves from malpractice suits?" And, "Are protections against unwarranted malpractice lawsuits needed to decrease the unnecessary use of diagnostic tests?"

Overall, 91 percent of doctors surveyed agreed with both statements.

Survey co-author Dr. Tara Bishop, an internist at Mount Sinai School of Medicine in New York, said the results jibe with what she hears from colleagues.

"When you sit around at a dinner party with doctors, malpractice fears and a kind of hatred of the malpractice system really comes up as a common theme," Bishop said.

Paul Perantinides, a medical malpractice attorney in Akron, Ohio said most of his cases involve doctors failing to test – a point that Bishop said emphasizes why doctors sometimes order so many tests.

Bishop said lawsuit fears sometimes play a role in her own decisions to order tests, "particularly if it's a high-risk patient."

Bishop noted that defensive medicine is estimated to cost the U.S. health care system billions of dollars each year, and said many doctors worry they could be sued even when they follow standard-of-care guidelines.

Patient advocate Helen Haskell of the group Mothers against Medical Errors said she isn't surprised so many doctors say they overtest because of malpractice concerns.

"I think they certainly believe that, but at the same time the overtesting is both easy and profitable for them rather than spending time with the patient ... to get to the root of things," said Haskell, of Columbia, S.C. Her 15-year-old son died in 2000 from a medical error after elective surgery. Doctors agreed to a hefty settlement without a lawsuit being filed.

Bishop and colleagues randomly selected doctors for the survey from an American Medical Association list of U.S. doctors. A total of 2,416 were mailed surveys starting in June last year; half sent in responses and data collection ended in October. The survey was funded by a grant from the Robert Wood Johnson Foundation and was part of a broader study on doctors' views on health care reform.

Overall, almost 93 percent of male physicians said doctors order unnecessary tests because of malpractice concerns, versus 87 percent of female physicians. Equal numbers of men and women said protection from unwarranted lawsuits is needed to decrease overtesting.

The survey didn't ask doctors if they personally ordered needless tests because of malpractice concerns, or if it is the major reason for overtesting. It also didn't ask them to name specific malpractice reforms they favor, although many doctor groups including the AMA have pushed for limits on malpractice awards.

____

Online:

Archives of Internal Medicine: http://www.archinternmed.com

Comments

[Damiano Iocovozzi MSN NP]

09:42 AM on 07/12/2010

The lawsuit fear is highly overrated, especially with specialists In the US we currently spend 25% of the health care dollar on medical futility, especially on those who have exhausted every medical option and may have only six months left to live. Now, just follow the money. As people deteriorate from a natural disease process or advanced old age, the spending on the Titanic just amplifies to about $10,000 per day per patient in ICU where specialists call in other specialists who order every test, lab, med, surgery and even trips to the cath lab, all designed to abuse, waste and defraud the payer. At the end of this fool's errand, the patient still dies, but in a horrible way usually on life support with a huge endotracheal tube from mouth to lungs, scared, in pain, turned, suctioned, medicated for no accomplishment of one generic medical goal. The more honorable solution: hospice which allows the person to die in his own home for about $100-$450 per day, supervised by the visiting nurses. Please visit my web page at soonerorlaterbook.com to listen to many prominent radio physician personalities talking about these issues. The worst scene of the crime is the moment of death where a loved one cannot even get to say good bye due to intubation. Believe me, I know, I have spent 23 years at the bedside.

[logic-a-go-go]

11:10 PM on 07/01/2010

If that's what it takes to get me the tests I need, well then, fine.

[DennyCrane]

11:35 AM on 07/01/2010

10 in 10 docs won't admit that the more tests they order, the more they get paid. The impact of defensive medicine on the cost of health care has been studied. You know what they found? That it only contributes to 2% of the costs. Maybe if doctors were salaried and had a results-based model instead of a pay-for-service model, health care wouldn't be so expensive. Guess which hospitals rank best in quality of care. Mayo and the Cleveland Clinic. Guess what distinguishes these hospitals for every other hospital. Their doctors are salaried so they have no financial incentive to order unnecessary tests.

[KristinNoelle]

08:33 PM on 07/02/2010

That's not really true. Most tests are conducted by different departments than where the test was ordered. When an ER doc orders x-rays, the charge comes from radiology; if he or she orders an echo, the charge comes from cardiology. Also, with HMOs and stock options, there is actually incentive not to order excessive tests because the fees are fixed.

I would tend to disagree with the 2% figure. Explicit costs (litigation costs, damages, and settlements) might work out to 2%, but it is impossible to determine the dollar amount of extra services due to fear of lawsuits, especially since many doctors order certain tests out of habit as opposed to a case-by-case analysis of the chances of getting sued.

[Conk]

09:35 AM on 07/01/2010

BS! It's mostly about the money and sucking you deeper into the allopathic system.

[arizonaslim]

03:22 PM on 06/30/2010

I'm one of those self-employed people with high-deductible insurance. Which means that, if I'm getting a test, I have to pay for it.

So, I don't exactly make myself popular when I start questioning the cost of said tests. I've also found that if I say the price is too high for my budget, well, the necessity of that test just up and vanishes. Funny how that works.

[dmac]

12:34 PM on 06/30/2010

Medical Malpractice awards are roughly half of 1% of total medical costs and have been declining steadily for over 10 years. If the doctors have an arguement, they should be having it with the insurance companies who are gouging them.

http://www.citizen.org/documents/NPDBFinal.pdf

And yes, I expect that when asked, the doctors would say they are concerned about that particular bogeyman, even if they know better. Puts them in a better light. Ordered tests also pay for the equipment they've purchased to do the tests in-office, or profit a partially-owned lab or facility, or simply scratch someone else's back. Can any of us patients tell the difference between necessary tests, over-testing, and fee padding? Preventative medicine is righteous. Fee padding is greedy. What do you expect them to say?

I lived in the Uk for almost ten years. During my first visit to my GP, I presented my US medical records and told him my Dr recommended I be given a particular test every 6 months. UK GP told me I needed it every two years. I mumbled something about different research on both sides of the Atlantic and he said, "No, the research is the same. You'll find you need more tests when you have to pay for them." That was 1983. Nothing's changed.

[daedalus43]

08:11 AM on 06/30/2010

They all have malpractice insurance, and that costs a bit, but the actual lawsuit payout to the injured party is very small compared to the cost of healthcare. So, who's actually making money in this system?
1. Doctors (I'll bet 9 out of 10 think they're being paid too little ... how about that survey?)
2. Insurance companies.

And, by the way, many doctors either own the machines on which they order tests or have a financial interest in the testing clinics, so they "double dip". 9 out of 10? Maybe.

[bobell]

09:13 AM on 06/30/2010

i know doctors. they pay over $200,000 dollars a year for malpractice insurance each. Tests are sent to labs. Every doctor that sends a test to a lab has a financial intrest in the lab? i dont thinks so.
No matter if you think the docs are greedy or not, we, as a country, do more testing than any other country in the world. This is why we have the most expensive health insurance in the world, testing costs money, no matter what kind of health reform bill is passed, the cost of health insurance will not go down until this problem is addressed.
if we insist on overtesting and monetarty awards to patients that are way out of line, we will always have the most expensive health insurance in the world, but not necessarliy the best health insurance in the world.

[daedalus43]

01:39 PM on 07/02/2010

By substituting "every" for "many" in my assertion about doctors having financial interest in cllinical facilities, it is clear you have an agenda. I would suggest that in a fair system, the adjective ought to be "no"! Socialized medicine is the answer, but I doubt that you'll agree.

[madtube]

09:01 PM on 06/29/2010

This affirms my belief that lawsuits are the reason for the exploding price of health care.

[daedalus43]

08:23 AM on 06/30/2010

Well, a "belief" can't be tested by rational means. This was a survey of people with a vested interest in diverting attention from a healthcare system which is twice as expensive as others in the developed world and gives worse results. The reason for the diversion is evident: doctors in the US are (on average) paid higher (as a percentage of average income) than anywhere else in the world. The current system is serving them very well (thank you!) at the expense of everyone else (particularly the average citizen).
Want to get rid of malpractice lawsuits? Try nationalized, universal healthcare. If a Doc. messes up, they can rush you back to fix it up at no cost to you. If a Doc. messes up too frequently, he will be purged by the central authority (because he is too big a cost for the taxpayer to support).

[bobell]

09:27 AM on 06/30/2010

check opensecrets.org. lawyers and lawfirms are the largest lobby group with reid being the top recieptiant of money $2mill. i would assume that that had some influence in the drafting of the health reform bill and the resistance to torte reform.
health professionals are #2. the truth may be murkier than : doctors= bad.

[bobell]

09:31 AM on 06/30/2010

add on: no torte reform due to lawyer lobbyists, we have to buy health insurance, but doctors dont have to accept health insurance due to health professional lobbyists.

we are the ones who lose.

[bbtri]

01:59 PM on 06/29/2010

Oh, they aren't making any money off those tests/