Types of Defensive Medicine
Defensive medicine happens when doctors order tests or medical treatments that are not necessarily in the best interest of their patients. They do this, not for the health of their patients, but to protect themselves from the possibility of legal actions in the future. According to a survey reported by the JAMA Network, 93% of doctors reported practicing defensive medicine.
There are two forms of defensive medicine, assurance behaviors, and avoidance behaviors. Assurance behaviors or “positive” defensive medicine, involve providing additional services to ensure that legal standards of care were met to avoid malpractice claims. Avoidance behavior, or “negative” defensive medicine, refers to physicians’ efforts to avoid high-risk patients and procedures.
Why Doctors Practice both types of Defensive Medicine
Assurance behavior in medicine is very common, according to JAMA Network. Assurance defensive medicine involves prescribing additional, unnecessary services, such as diagnostic imaging, to avoid medical malpractice claims.
Avoidance behavior occurs when providers refuse to perform risky procedures or accept high-risk patients because these elevate the risk of litigation. According to the JAMA Network, 42% of doctors reported that they had eliminated procedures prone to complications and avoided patients with complex medical problems within the last three years.
Why does Defensive Medicine Happen?
Defensive medicine happens when a doctor acts not to help the patient, but to prevent a malpractice lawsuit if something goes wrong. This includes performing procedures the patient wants even if they aren’t clinically necessary. In addition, the doctors in this situation may order extraneous diagnostic tests or refer patients to specialists to rule out possible but very unlikely conditions to cover all bases. This is how defensive medicine leads to overtesting and possibly, overtreatment.
How much does Defensive Medicine Cost?
Experts believe that defensive medicine is a significant reason for rising healthcare costs in the United States. According to a study published in Health Affair in 2018, it is estimated that defensive medicine adds $25.6 billion to healthcare costs each year, comprising as much as 34% of all healthcare costs in the United States. In addition to financial costs, the National Institutes of Health says that defensive medicine has negative consequences for patients, doctors, and the patient-doctor relationship.
Can Defensive Medicine be Reduced?
According to the National Institutes of Health, the following should be done to reduce defensive medicine.
- Doctors must be allowed to spend more time with their patients. Even though this may mean hiring more personnel, if defensive medicine is reduced, it may actually decrease health expenditures overall.
- Physicians must stop the disproportionate ordering of tests in an attempt to obtain diagnostic certainty. There will always be imperfect data and unpredictable patient responses to treatment.
- There must be changes in healthcare attitudes, from a punitive attitude to one that favors identification and correction of errors.
- Decriminalizing medical mistakes and handling them in civil courts may also help.
Carpey Law’s Views on Practicing Defensive Medicine
While defensive medicine is not going away, Carpey Law believes there are three types of defensive medicine that should be taken out of the medical malpractice equation:
- Tests and evaluations that are actually good for the patients
- An additional treatment that is motivated, not by fear of lawsuits, but by fear of harm to the patient
- Patient-directed defensive medicine (when the patient seeks tests the doctor would not necessarily recommend).
In addition, the fact that medical testing equates to profits for doctors and hospitals is a real issue. Doctors and hospitals should be allowed to make money like anyone else. But medical testing on patients positively affects the bottom lines of medical providers, and that is something we as consumers shouldn’t overlook.
- NIH(1) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3728884/
- NIH(2) https://www.ncbi.nlm.nih.gov/pubmed/26572999
- NIH (3) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4231873/
- NIH (4) https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163143/
- JAMA Network – https://jamanetwork.com/journals/jama/fullarticle/200994
- AHRQ https://psnet.ahrq.gov/web-mm/defensive-medicine-glowing-pain