On the Defense

Defensive medicine practices are common and costly

/ Author:  / Reviewed by: Joseph V. Madia, MD

(RxWiki News) For years, researchers have known that physicians use defensive diagnostic procedures for their patients, usually to little benefit. For the first time, a thorough study confirms that doctors often order such screening.

Defensive screening procedures used to diagnose patients are often administered by physicians just to avoid a lawsuit. According to John Flynn, M.D., Associate Chief of Orthopedic Surgery at Children's Hospital in Philadelphia, many lawsuits against doctors depend on the plaintiff's lawyer's claim that the doctor should have ordered additional diagnostic testing.

In the past, defensive medicine practices were primarily measured using surveys that simply asked physicians if they practiced defensive medicine. This more in-depth study by Flynn and colleagues provides a more accurate measurement of defensive medicine practices.

The study included over 2,000 patient-doctor encounters involving 72 orthopedic surgeons from Pennsylvania. The researchers found that 19 percent of imaging tests were ordered for defensive purposes, accounting for 34.8 percent of total imaging charges for all the patients involved in the study.

The high prevalence of these costly defensive procedures, says Flynn, is largely driven by the legal environment that leads physicians to order extra tests. Not only does this environment lead to high costs, but it also means that many patients are subjected to tests they would otherwise not have to go through.

Flynn says that he was most surprised about which surgeons were more likely to practice defensive medicine: those who had been practicing for more than 15 years. One would think that those immediately out of medical school would order more defensive tests because they are less confident about their abilities. However, it was those physicians who had practiced for many years that ordered the most tests, likely because they become more aware and concerned about the potential of a patient second-guessing them.

Flynn hopes that his study will lead to further research that looks at the larger, nationwide prevalence of defensive medicine. If researchers were to perform similar studies of doctors' from all specialties, says Flynn, we would have a way to measure how much of healthcare resources are wasted on defensive medicine.

Flynn recently presented the findings from his study at the 2011 Annual Meeting of the American Academy of Orthopedic Surgeons.

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Review Date: 
February 16, 2011
Last Updated:
February 16, 2011