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PubMed1998

Act first and look up the law afterward?: medical malpractice and the ethics of defensive medicine.

This essay examines the so-called phenomenon of "defensive medicine" and the problematic aspects of attempting to maintain the safest legal position possible. While physicians face genuine litigation threats they frequently overestimate legal peril. Many defensive practices are benign, but others alter patient care and increase costs in ways that are ethically suspect. Physicians should learn to evaluate realistically the legal risks of their profession and weigh the emotional, physical, and financial costs to the patient before employing a defensive measure.

American Medical Association↗
PubMedDate not supplied

How much does defensive medicine cost?

Many key health reform bills in the 103rd Congress include proposals to overhaul the medical malpractice system. One of the factors motivating such legislation is the practice of defensive medicine, or care that does not benefit the patient and is provided solely to avoid malpractice claims. Estimating the costs of defensive medicine is difficult because of the many conflicting and overlapping motivations facing physicians. Although our estimates delineate a wide range of potential savings, systemwide savings from aggressive malpractice reform could approach $41 billion over five years.

Cost Savings↗
PubMed1997

Malpractice, defensive medicine, and obstetric behavior.

OBJECTIVES: The authors examine 58,441 obstetric deliveries in New York State outside New York City to test for the existence of defensive medicine in obstetrics. METHODS: The data consist of merged vital statistics and hospital discharge records from the New York State Department of Health, together with other merged variables. Physician fear of malpractice is proxied by cumulative obstetric malpractice suits by county for 1975 through 1986. A generalized probit analysis is used. RESULTS: Malpractice exposure is shown to influence slightly the use of the electronic fetal monitor (EFM), a major diagnostic tool. Use of the EFM is shown to influence the diagnosis of fetal distress; fear of malpractice influences this diagnosis both directly and through the EFM. The diagnosis of fetal distress significantly affects the choice of cesarean section (c-section) as a method of delivery; hence, fear of malpractice influences the choice of a c-section both directly and through the diagnosis of fetal distress. Failure to include indirect effects via diagnostic procedures and diagnosis would result in an underestimate of the effect of fear of malpractice. Of an overall c-section rate of 27.6% in the data set, fear of malpractice accounts for an estimated 6.6 percentage points, of which 4.4 percentage points reflect a direct effect, and the remaining 2.2 percentage points reflect the effect of malpractice exposure on the use of the EFM and, directly and indirectly, the diagnosis of fetal distress. CONCLUSIONS: The results appear to confirm the existence of defensive medicine in obstetrics. Whether this is a desirable or undesirable effect remains ambiguous, but it is costly.

Cesarean Section↗
PubMed2005

Are neurology residents in the United States being taught defensive medicine?

OBJECTIVE: To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents' attitudes. METHODS: Neurology residents in the US (n=25) and, as a control group, Neurology residents training in Germany (n=42) were asked to rate multiple items regarding litigation, defensive strategies and how often these issues are raised by teaching physicians. Statistic analysis was performed using nonparametric tests. RESULTS: Residents in both countries indicated that litigation is an "important problem", although US residents stated this significantly more often (p<0.001). Initiation of tests motivated mainly by fear of litigation (p=0.004) and explicit teaching of defensive strategies by teaching physicians (p<0.02) were reported more often by US residents. CONCLUSION: Neurology residents in both the US and Germany perceive a litigational threat, but significantly less so in Germany. This difference may result at least in part from teaching of defensive strategies reported more often in US programs.

Defensive Medicine↗
PubMed1996

Defensive medicine and tort reform: new evidence in an old bottle.

Quantitative analysis of medical liability's influence on medical practice is a small but growing field. The three foregoing articles illustrate three of the possible analytic approaches: case study of technological diffusion, survey of physician responses to detailed clinical scenarios, and multivariate analysis of the relation of physicians' scenario responses to objective liability experience. The articles also offer a good picture of the state of the art: Many difficulties hamper research in this area, and these articles, like others, offer considerable illumination but leave much uncovered. Defensive medicine surely exists, but its effects on health care spending and access are unclear. The most important lessons for public policy are that tort reform may be necessary but not sufficient to reduce the problems associated with defensive medicine, and that the major malpractice problem continues to be malpractice.

Defensive Medicine↗
PubMed2000

Trends in negative defensive medicine within general practice.

Negative defensive medical practice has adverse consequences both for individual patients and for public health. This paper reports the results from a survey conducted in 1999 in which certain features indicative of negative defensive practice were compared with an identical survey conducted five years previously. Responding general practitioners stated that they are now significantly more likely to undertake diagnostic testing, refer patients, and avoid the treatment of certain conditions.

Defensive Medicine↗
PubMed2002

Defensive medicine.

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Defensive Medicine↗
PubMed1993

Defensive medicine.

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Defensive Medicine↗
PubMed2007

Unconscious defensive medicine: The case of erythrocyte sedimentation rate.

BACKGROUND: We investigated physician rationale for and against performing routine erythrocyte sedimentation rate (ESR) tests during hospital admissions. METHODS: A comparative, descriptive, prospective study among 82 physicians in 15 departments of internal medicine from two University Medical Centers - A and B - in Israel was conducted between July and August 2004. Reasons for physicians' use of ESR were examined using a confidential questionnaire. A panel of four experts reviewed the need to perform an ESR test in 100 patients' files from center B. The main outcome measures were the use of ESR in routine hospital admissions and reasons for use. RESULTS: Forty-four vs. zero physicians from medical centers B and A, respectively, routinely perform ESR tests for all admitted patients (p<0.001). According to the experts, in only 10-30% of the 67 new patients could ESR tests have been of some value. Reasons for performing ESR routinely were as follows: to identify severe and "hidden" diseases (21/44, 47.7%); because it is crucial for all patients, both new and returning (10/44, 22.7%); because it is a guideline from department head (6/44, 13.6%); it is recommended in the literature (5/44, 11.4%); don't know why (2/44, 4.5%); defensive medicine (1/44, 2.3%); and other (6/44, 13.6%). CONCLUSION: Routine use of ESR tests on admission can be explained by old habits and by an unconscious concern about liability, i.e., unconscious defensive medicine.

Journal Article↗
PubMed2000

[Effects of defensive medicine on costs].

Physicians who give priority to the reduction of their exposure to malpractice as compared to the health of their patients practise defensive medicine. Far-reaching yieldingness to unjustified requests of the patients in order to avoid unpleasant quarrels also falls into this category. Among other things, an increase in diagnostics, consultations and in-patient treatments as well as a decrease in risky medical measures are the consequences. Investigations performed mainly in the U.S.A. and to a minor degree also in Holland and the U.K.--but none in Germany--have clearly shown that global medical costs can considerably be forced up by defensive thinking and acting of the physicians. As an example, the increase in the rate of Caesarean sections based on defensive reasoning is discussed. The defensive way of acting in daily medicine is predominantly a response to stringent jurisdiction often obviously favouring the patient's claims. Thus, indirectly the respective judges also bear responsibility for the explosion of medical costs!

Cesarean Section↗
PubMed1987

Defensive medicine.

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Defensive Medicine↗