Does Defensive Medicine drive down malpractice claims?

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Defensive Medicine

Recently, a study was released that shows there is a higher use of resources by US physicians which is associated with a reduced risk of malpractice claims.  These findings were published in a study by The BMJ.  However, the researchers say it is uncertain whether higher spending is defensively motivated.  Defensive medicine is defined as medical care provided to patients solely to reduce the threat of malpractice liability rather than to further diagnosis or treatment.

The study was done to investigate whether physicians who provide more costly care in a given year are less likely to face malpractice claims the following year.  They looked at information on nearly 19 million hospital admissions in Florida between 2000 and 2009 to the malpractice history of over 24,000 physicians in seven specialties.  They looked at several specialties.  First, they looked at internal medicine.  They found the probability of experiencing an alleged malpractice incident in the following year ranged from 1.5% in the bottom spending fifth ($19,725 per hospital admission) to 0.3% in the top fifth ($39,379 per hospital admission). Similar associations were seen among pediatricians, surgeons, and obstetricians. Regarding obstetricians, they looked at whether obstetricians with a greater tendency to perform caesarean deliveries in a given year had lower malpractice claims the following year.   Overall, 4,342 malpractice claims were filed against physicians (2.8% per physician year). Malpractice rates varied across specialty, ranging from 1.6% per physician year in pediatrics to 4.1% per physician year in general surgery and obstetrics and gynecology.   Across all specialties, greater average spending by physicians was associated with reduced risk of incurring a malpractice claim. Family medicine physicians were the only physicians where this association was not observed.

The authors say their findings suggest that greater resource use, whether it reflects defensive medicine or not, is associated with fewer malpractice claims.

Tara Bishop and Michael Pesko at Weill Cornell urge physicians to take caution with this study.  They argue it is too early to make the conclusion that defensive medicine will protect physicians from malpractice claims.  If this study is to bring anything, it is the need for future research in this area.  It may be tempting for physicians to use the results to justify ordering unnecessary tests and procedures in order to reduce their malpractice risk, they explain.

Regardless, maybe some defensive medicine will help those of us who present to the hospital and our health care providers office and need some answers rather than more questions.

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