Doctor Anxiety and Malpractice Avoidance

The effect of malpractice lawsuits on health spending continues to be debated.  The biggest concern is not the actual costs of the lawsuits and any awards, but the effect of behavior designed to avoid such litigation, commonly referred to as defensive medicine.   (HA Article)   The authors used the 2008 Health Tracking Physician Survey to ascertain the level of anxiety doctors appeared to have about malpractice and then looked at Medicare claims from 2007-09 for the amount of diagnostic testing on these physicians’ patients who had chest pain, headache or lower back pain, common conditions with great uncertainty about cause and treatment.  In an analysis adjusted for patient and physician characteristics, the researchers found that patients with chest pain had a higher likelihood of being referred to an ER if their physician had a high level of malpractice concern.  Similarly for headache patients treated by a doctor with a high level of concern, there were more advanced imaging tests and such back pain patients also had more imaging.  Overall, the researchers concluded that a doctor’s malpractice concern level was associated with doing more of at least certain types of tests and potentially other actions like ER referrals or hospital admissions.    Although a relationship appears to exist between a specific physician’s perceptions of malpractice risk and defensive medicine, the relationship has not been found in other studies which look at the malpractice “environment”–i.e., state laws, level of premiums, level of awards, etc.  This would suggest that, as makes common sense, it is better to understand a particular physician’s behavior than to try to do aggregate analyses and that one key to lessening defensive medicine might be to rationalize doctor’s fears about being sued.