Doctors' practice of "defensive medicine" widespread, costly

...and, it can't hurt that these doctors make more money when they order more tests! Doctors are greedy narcissists who prey on the sick to live their extravagant lifestyle.

I actually think that's good! I've had to ask doctors for tests they thought were unnecessary, only to find out that there WAS a problem.

They should be sued to stop the extra tests. Any lawyers out there?

Thought this sounded like what you went through.

Of course they do. In our litigious society, combined with their high malpractice premiums, that is what they are driven to do.

This is a serious article? Of course the doctors say that they are ordering unnecessary tests. They want immunity from malpractice suits. Where is the questioning of the data? Where is the evaluation of what the study means? How do we know the data is valid? Please

Sky blue- Film at 11

Every doctor is afraid that a client attorney will have him on the stand and ask him "Is such and such test conclusive for that defendant has endured for ?
Doctor: "yes"
Lawyer: Then why didn't you run it and save them the pain of enduring this awful disease?

So lots of unneccessary tests get run to rule out things people MIGHT have.

It will be so until we find a new means of reducing errors and compensating the injured.

The healthcare sector is still a joke. Everyone is making money but me, because I am paying for it. On top of that I can't even get my doctor (or dr's assistent) to even call me back.

People get upset about the price of health care and are making no steps in tort reform. People get upset about high premiums and will always sue the physicians.

Gotta prevent these inane lawsuits and steep rewards.

Think about this the next time you complain about your health insurance rates.

Not a surprise. But, tort reform is nearly impossible, as most of our elected officials are trial lawyers! It is much simpler to outlaw drug company pens, which will accomplish nothing. The right to sue for anything must have a cost-you cannot have your cake and eat it, too.

Wow. Stop the presses. What a revelation.

You mean the tort system acts to cause people to limit their liability.

What about the promise to Hippocrates?

Does this shock anyone?! I've been saying this for years. It like me saying I have a soar throat and a fever. And the doctor will do a test and comeback, "Well we've tested you and you don't have a hang nail or an ankle sprain." Four co-pays later and much time wasted. All because Dr. Defensive doesn't want to do his job. Maybe the hospitals can put out a watch list of abusive/ excessive patients who sue. I don't know. But this system isn't helping anyone!!

Did they also ask the doctors about how many deaths and injuries were avoided because they did their job and ordered the tests and procedures?

Did they also ask the doctors about how many deaths and injuries were avoided because they did their job and ordered the tests and procedures?

I think the term "defensive medicine" is a misnomer and very misleading. It's not like these medical tests are ordered just to order tests. They are probably ordered to ensure that the proper diagnosis is made. Regardless of how accurate a science people want medicine to be, it is really just practitioners making the best guess they can based on the evidence they collect; some guesses are easier than others. But ordering tests to be sure of making the correct diagnosis sounds like a no brainer to me. Anyone out there want a doctor to order less tests and increase the risk of making a mistake? I didn't think so.

Seems to me an "unnecessary test" is one that is not performed on you. If it were your child and there was a 1 in 20,000 chance that something could be seriously wrong with them, wouldn't you want that test one? Isn't that what we have insurance for? As long as I am happy with the price of my insuarnce (or the price of the test if paying on my own), no test is "unnecessary"; some are just less likely to be helpful in fixing the most likely cause of the problem.

Doctors only order more tests when they (or the hospitals) can financially benefit. They are reluctant to order tests that may cut into profits- such as tests that might deselect a more expensive drug over a cheaper drug. This is especially disgusting (imo) in oncology- tests are available (clinically validated, FDA approved, etc. tests) which will tell a doctor whether or not certain drugs will work, but they are used infrequently because physicians get paid for the drugs they prescribe. Including chemo. We are the only country in the world that allows this. Think about that for a few minutes.

I hope that going forward juries will consider this type of problem when giving outrageous awards. While I think about 10%-20% of lawsuits against hospitals and doctors may have some merit, I would guess that the remaining 80% to 90% are for either monetary gain or because people need someone to blame when something goes wrong, even if no one could have prevented what had happened. In general, when someone sues a doctor or hospital, they are driving up the costs for everyone else and that is one more emergency room that might have to close or one more doctor who refuses to deliver babies because he fears he will be sued if something happens and this is bad for all of us. Tort reform is necessary before medical costs begin to be controlled.

It seems that one of the best things the government could do for the health care system is reforms around malpractice liability. Practices such as the ones in the article and the ridiculous cost of malpractice insurance is something that all of us pay for to fund the lawsuits by a minority of patients.

Health care onsumers view Boston Teaching Hospitals as the "mecca" of care, and they place other well trained and competent physicians on the defensive when they insist on consultations from Boston specialists. The Boston teaching hospitals encourage this view through a variety of behaviors, and the utilization of their hospitals for consultative care generates them revenue through procedures and is self serving. This also "clogs" the system by increasing the wait time for specialty consultations in medical specialties that are underserved in MA. Although tort reform has been the focus in recent years, this problem is not just about the need for tort reform.

The recent $13 million verdict against the DFCI docs that didn't test for flesh eating bacteria in their patient with diarrhea didn't help. If testing for flesh eating bacteria in every patient with the runs becomes standard, healthcare costs will sky-rocket.

This spring I was at a medical meeting regarding health care costs and an official from the US Government Accounting Office stated that defensive medicine "... if there is such a thing..." is an infantismal portion of US health care spending. When challenged by members of the audience, he cited a study he knew about that compared health care costs between a capitated HMO and a defined plan HMO as the basis for his statement. I am sure many who read this thread are confused as to what the different HMO plans mean as well as the assumptions behind such a comparisons, let alone assertions. I believe the GAO is in need of serious education regarding "defensive" medicine because, if the reality does not fit with the accounting in health care costs, then moving towards affordable health care for all will fail on the rock of ignorance. Such ignorance would also lead to failure to mandate uniform tort reform to go along with universal health care.

I would be very interested to know how the referral and test ordering patterns relate to evidence-based practice. Could some of these docs be practicing what they perceive to be "defensive medicine" when in fact it is the indicated course of action?

Administering asprin after heart attack is a classic example of a practice that is well supported by numerous studies as the proper course of action, yet many physicians fear that it can raise the risk of bleeding and do not like to do it. Would a doctor that complied with this practice out of fear of litigation be "practicing defensive medine" but also doing the right thing?

I am in medical school, granted not in MA. but we are told the same thing... do this test to protect yourself, do that. there is a ton of unnecessary dignostics beign ordered solely to insulate from lawsuits. consider that it is happening in all 50 states... thats at least 50 to 100 billions dollars that doesn't need to be spent. tort reform would be rather helpful no? better yet, we've be told do an MRI so the insurance company will pay you even though we already know the ACL is torn. even more waste... it doesn't have to be this way.

I know healthcare is brutally expensive, but if 5% of those "unnecessary tests" uncover a potentially life-threatening condition, wouldn't the patient in question feel it was worth it? Lawsuits are often frivolous, but enough juries thought the doctor being sued was negligient.

Two sides to every story, White Coat.

Tort Reform, attornies are killing the middle class and raising the cost of doing business across the board.

This is a long-known entity--we call it CYA medicine (Cover Your A**) I am a healthcare provider who is floored at how sad this is. It takes away from the true 'art' of medicine, gut-judgement, etc.
Sad. And costly. But we all have to do it, unfortunately in this legal-minded world we live in.

The doctors aren't the problem its the lawyers because you can sue for anything now a days!!!!

Physicians, especially ones practicing in high-risk areas such as OBGYN, are not swimming in the dough they once were. Malpractice premiums can range anywhere from $20,000 a year in less populated areas to $100- $200,000 in large metropolitan areas like Detroit, Miami and Boston. Would you like to pay six figures in insurance just to be able to do your job? And whenever the liability insurance company has to pay out to defend or indemnify the doctors, the premiums go up. Or the insurance company goes belly-up, which has happened as well.
The lawyers are the ones making the money here - the ones hired to defend the doctors, whether the suit has merit or not or whether the plaintiff wins or not, and the plaintiff lawyers who take at least a third of their client's verdicts.
We should instititue a tort system similar to ones in Europe - if a plaintiff takes a case all the way to trial, and loses, they pay back the defendant's legal fees. How would those plaintiff lawyers like them apples? That would at least encourage settlement before trial, and discourage weak cases from ever getting too far...

Is there anyone who would agree in writing not to sue their physician in return for an appreciable reduction in their health care insurance? I think I would. But then again, I'm fairly knowledgeable in the health-care field and would have a good idea of the usual course of treatment for my symptoms.

What many people don't realize about certain tests are the potential issues with things such as CAT scans. Many people come in to their doctor's offices or emergency departments demanding this test. There is the notion that this modality will answer all questions and give the diagnosis. There is a significant amount of radiation associated with this test. Many studies are showing the increased risk and potential incidence of CANCER that will be caused by something as simple as a single CAT scan of the head, especially in children. The cost of defensive medicine that we are performing now will exponentiate in 20 years when we are treating all of these Cancers. Not to mention the kidney destructions caused by IV dye....

What kind of "survey" was this?!? The Mass Medical Society asking it's own members, "hey are you ordering more tests" because you're afraid you might get sued if you don't get the diagnosis right?" Answer, "yes"! So what's the problem? Doctors are being more caaaarrrrreeeefulllllll! That's a good thing! That will mean fewer law suits, better medicine, better patient outcomes .... Nice try, Globe!

What I find about my doctor is that she suggests tests that she wants to. IMHO it is passive aggressive. She resents my knowledge and will spew dumb tests just to shut me up. I get into the passive aggressive game too going though with them. I am practicing "defensive" health care in that if my doctor won't do the test I want (and makes the best sense) out of her sense of arrogance about what is best - I will take what tests I can to attempt to get a read on the thing I am concerned about. My doctor will also never tell me *why* she doesn't want to do a test. Seems to me it is up to doctors to stop acting like arrogant children (and blaming the big bad lawyers) and do their jobs correctly.

Doctor Sue
Are you a physician? - Are you a graduate school or college or high school Doctor Dr Sue - are you educated at a graduate level with your own focused expertise? Thus do you realize the value of judgement applied on a background of experience and facts. Do you have an internet driven view without any capability or training in data analysis? Do you have presumption that your expertise is equal to your physician's despite her extensive training ? Do you attempt to dictate your care rather than seek consultation and then decry arrogance when your own ignorance is revealed to you to be potentially damaging and costly? Please realize that you are the cause of the problem and then try to work with our well intentioned physicians by diminishing your uninformed consumerism

So some doctors are being extra careful because they don't want to get sued? And they probably do actually catch things that they otherwise wouldn't. They still aren't going to be ordering tests that are unjustifiable... no chest x-rays for a broken ankle. No aids tests, for flu symptoms. There is probably some relation to the symptoms presented and the test ordered, even if the doctor is just playing it on the safe side...

We are paying more than enough money to the health insurance companies to expect that doctors will perform every conceivable test. How about the 50% cut that the health insurance companies are taking out of every health care dollar? How about we start cutting that waste first. The only reason the health insurance companies are still in business is because it gives thousands of mindless paper pushers jobs and that is what makes the politicians happy. Nice plump tax payers to tax.

With some of the comments here, I can understand why the Doctors are afraid. If all they wanted was money or luxury, they would have trained to be investment bankers. Medicine is an 'inexact science' and people expect perfection. So that's why they order the tests. Remove the expectation and the proliferation of liars...er, I mean lawyers....will be unnecessary in Massachusetts.

What did Shakespeare write in King Henry VI, Part 2, Act 4, Scene II?
"The first thing we do, let's kill all the lawyers."

As a physician I'm not surprised by all the misinformation circulating on this board. Of course physicians order tests that are unlikely to lead to a change in patient management. They do this to rule out problems that are highly unlikely, but if the problem exists, it could lead to a bad outcome for the patient (and ultimately the doctor, in court).

I'll give you an example from my recent experience. I witnessed a colleague perform a therapeutic injection on a patient in which the patient had an excessive pain response to placement of the procedure needle, despite seemingly adequate local anesthetic injected at the skin. It could be that this physician was lousy at giving local, or that the patient is unusually sensitive. But what if a deep-seated infection existed in the area that had not been previously detected, and that the patient did not have symptoms for? Seemed like a big stretch of logic to me, but this doctor was about to inject steroids into the patient. Suppose the patient did have an infection there, and now we just exacerbated it by giving the patient steroids? What if the patient goes into septic shock and dies due to this misadventure?

So he ordered an MRI to evaluate the area for an infection. A very expensive test to rule out something that was highly unlikely.

Guess what? On the MRI report, the radiologist saw some unusual findings that could just be degenerative disease- or it could represent signs of metastatic cancer! So the radiologist covered his butt by recommending a bone scan and CT.

The patient will likely get both.

See how this happens?

In the past, a doctor may have just relied on clinical judgment, and spared the patient unnecessary tests, and the payment system a wad of cash. Now clinical judgment is no longer acceptable. Your judgments as a physician have to pass legal muster in a court of law. And as long as we have to meet that standard, we won't take one iota more risk than is necessary. And that is costing us all a lot of money to avoid the few bad outcomes that would result if we weren't so risk averse. But don't forget to look at the flip side of that conclusion, how many bad outcomes can be attributed to unnecessary testing?

I've heard of far too many cases of a patient undergoing a test based on a soft call that led to more testing, then biopsies, then complications, then ICU time, trachs, PEGs, DNR/DNIs, then the morgue. FAR too many.

Lets be honest here...

I am guessing you are a doctor. Wow hear that arrogance...why don't our "well intentioned physicians" start working with their patients -- no matter what their *credentials* -- rather than fighting with them for bragging rights as to expertise. As for being part of the problem, there is no problem. Doctors just want to be in control and not held accountable. Thank god the law is the only thing that can keep them accountable and their arrogance in check.

The only Guarantee about the human condition is that it is a variable.. Dr's need
the flexibility to use their judgment and common sense. We need to stop treating medicine like a profit and loss business and remember it is a service. We need to manage expenses accordingly to the mission of wellness not litigation.
My family and I have been the victims of lack of proper testing. I myself am non-standard and hard to diagnose as a result I have almost died twice due to failure to diagnose what was wrong. The issue is not about unnecessary testing as much as ensuring the ability to diagnose correctly and be mindful of procedures that can create Life threatening responses.
Marcia
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OK first of all I work for an insurance company and of every premium dollar that is received by this company 86 cents is paid out to cover medical costs of the members that only leaves 14 cents of every dollar paid to the insurance company to cover all administrative costs and salaries, and this is a non profit organization. For those who say that the insurance companies are only in it to get money that is un true, there are reasoned for the limitations of coverage and hoops for "branded drugs", think of it in this manor, if the insurance company was to cover every test ordered or every medicine prescribed regardless of cost and no questions asked to make sure it is truly appropriate, then the cost of health insurance premiums would be at least 3 times the premium is today. and yes I have to pay my premiums as well just because I work for the insurance company does not mean that I get my insurance for free or don't have to go thru the same authorization processes as everyone else has to go thru.

and as for the comment above about the insurance company employing "thousands of mindless paper pushers " I am personally a college graduate with a bachelors degree in school for my masters, and the qualifications to work for the company require a college degree!

On the doctor's side: no doctors would order tests that do not associate to a patient's symptoms. Hence, no test is unnecessary. Doctors are not gods; no doctors know for sure what really went wrong inside the patient's body, and that's what those tests are for. He's doing it at the patient's interest too, not only his. They're trying to be safe, not only for them, but for their patients too. It's better to order 100 MRI which 99 returned normal than to miss 1 case of problem that will eventually lead to deadly consequences. After all, that's why we need doctors for, to make the safe bet on our own lives, and that's why we pay all those expensive insurance premiums and co-pays and deductibles for, for in case that if this rare instant happens, you are ensured that your life will be saved.. Let's look at the statistics: how many cases of death that are due to doctors who misdiagnosed because of not ordering the tests that they were supposed to order? How many cases of patients showing up in emergency rooms because their doctors told them that they don't have a serious medical condition? Even if a doctor orders 1,000 MRIs and only 1 shows serious problem, that is still worth it, because that also means he didn't miss 1 case. There is no price one can put on our lives! Life is priceless! Is the price of an MRI more expensive or the price of your own life? How would you feel that, after all those expensive insurance premiums you have paid for all those years, after all the trust you have for your doctor to save your life, you're dying because of a test that your doctor "thought" was unnecessary and too expensive for the insurance company and for you?
On a patient's side: no test is more expensive than my life. No test is unnecessary when it can possibly help explain my symptoms. I rather spend those expensive extra money and know that my doctor is doing everything he can to make sure I'm safe and that the inside of my body is looked at. Even when after all those expensive tests I paid for, they all come back normal, I'm still happy because at least I know for sure I'm ok, and that I can sleep without worries for many many nights to come. But when my doctor does not order those tests for me because he said I don't need those tests, and at the same time, can only explain most of my symptoms but not all of them, I will lose lots of nights of sleep worrying that I might have additional problem or something else inside my body that my doctor can't see. And if one day, I die because my doctor couldn't catch the disease earlier when he had a chance to just because he thought the test was unnecessary for me, and leave my family and friends pain and scarred because of my death, he is one murderer!