Majority of Docs Say Defensive Medicine Negatively Impacts Patient Care

According to a new national survey of physicians by Jackson Healthcare, 72 percent of physicians report that the practice of defensive medicine negatively impacts patient care.  Sixty-seven percent report that defensive medicine comes between the doctor and patient.

This survey is the third in a series of physician surveys by Jackson Healthcare to qualify and quantify the impact lawsuits have on medical care in the U.S.  It follows Jackson’s recent survey quantifying the cost of defensive medicine, in which physicians estimate $650 billion to $850 billion is spent each year on defensive medicine. Defensive medicine refers to the unnecessary tests and treatments that physicians order to avoid lawsuits.

“Nothing should come between physicians and patients, especially third parties like government bureaucrats and attorneys who have no medical training,” said Richard Jackson, chairman and chief executive officer of Jackson Healthcare.  “The physician/patient relationship is sacred and must be protected to the benefit of our physicians and us, their patients.”

Additionally, 75 percent of respondents believe defensive medicine will decrease the number of physicians in the U.S., perpetuating an existing physician shortage, and 87 percent of current residents and fellows reported that they were taught to practice defensive medicine. This has implications for the next generation of physicians, the future cost of healthcare and patient access to the care they need.

According to Jackson, “Without radical medical malpractice reform that gets at the root problem, not only will costs continue to climb, but our survey suggests that access, quality and innovation will continue to be limited to certain patients.  We need a balanced, common sense approach that guarantees patients their rights without undermining their care.”

Jackson Healthcare’s online survey also found that the impact of defensive medicine practices extends beyond inflating costs.  Its consequences are 1) limiting access to care for high-risk patients, 2) over- and under-treating patients with life-threatening illnesses, and 3) fostering distrust among patients and their physicians, which has resulted in lowered physician morale and manpower.

As long as physicians are personally financially liable for medical errors or omissions, they will continue to practice defensive medicine, because they have to put their careers, reputations and personal net worth at risk every day.  This is placing an unnecessary burden on patients by subjecting them to unnecessary tests and treatments, while inflating their out-of-pocket expenditures.

Key Findings from Jackson Healthcare Survey

• Physicians attributed 34 percent of overall healthcare costs to defensive medicine
• Nine out of 10 physicians (92 percent) reported practicing defensive medicine
• In cases of true negligence, nine out of 10 (89 percent) physicians agree that patients receiving negligent treatment should be compensated
• Emergency room, primary care and OB/GYN physicians are most likely to practice defensive medicine
• Younger physicians and female physicians reported less tolerance for risk and are more likely to practice defensive medicine
• Physicians who reported practicing defensive medicine, estimated the following:
• 35 percent of diagnostic tests were ordered to avoid lawsuits
• 29 percent of lab tests were ordered to avoid lawsuits
• 19 percent of hospitalizations were ordered to avoid lawsuits
• 14 percent of prescriptions were ordered to avoid lawsuits
• 8 percent of surgeries were performed to avoid lawsuits

Consequences reported to exist beyond the threat of the courtroom, included:

• Practicing “rule-out medicine” vs. “diagnostic medicine”
• Physicians appear afraid to trust their own clinical judgment and trust first-round tests, resulting in tests to confirm the results of tests
• Physicians expressed concern over not only missing a diagnosis, but being charged with delay in diagnosis
• Patients are viewed as plaintiffs, not partners
• Patient access to medical information and self-diagnoses via the web has increased physician compliance with patient demands in an effort to avoid lawsuits
• Physicians avoid high risk patients, because a bad outcome increases chances of litigation
• Physicians avoid procedures and practices that would increase medical malpractice insurance premiums, thereby limiting patient access to treatment
• Physicians are considering leaving the profession

Conclusions

An opportunity exists to save $6.5 trillion over the next 10 years.  However, traditional tort reform will not solve this problem.  It may reduce malpractice costs, but until physicians are protected from being personally financially liable for unintended mistakes and omissions, they will continue ordering unnecessary test and treatments to avoid lawsuits.

Click here for a PDF summary of the report.