The Cost of Fear of Malpractice Suits

It has been a while since we have looked at the role of defensive medicine, or testing and procedures generated from fear of malpractice suits, in health spending.  A Research Letter published in the Journal of the American Medical Association looked at the relationship between defensive medicine and the use of three hospital services.   (JAMA Int. Med. Article)   Thirty-nine hospitalists were involved in the study and were asked to rate their own level of defensiveness in regard to orders they actually placed in the treatment of patients.  Defensiveness was rated on a scale from zero to four and the costs of the various orders was collected.  An order not at all spurred by malpractice concerns was rated zero and various levels of defensiveness were represented from 1 to 4, with 4 being a completely defensive order.  The relationship between use of defensive orders and a doctor’s attitude toward malpractice was also examined.  Four physicians said they had no defensive orders and 21 had at least one order they said was largely defensive.  Twenty-eight percent of all orders were defensive to some degree.  Physicians with more defensive orders did not have significantly more total orders or significantly more overall cost per patient than did doctors with fewer defensive orders.  About 13% of total patient costs were identified as due to defensive orders.  Orders which were solely due to malpractice concerns were about 2.9% of costs, primarily via additional hospital days.  While the authors refer to this as a small amount of cost, even the roughly 3% number would be billions of dollars in savings a year.  Fear of malpractice is a real concern, both because of probably unnecessary utilization and cost it engenders, but also because it provides cover for physicians who may want to deliver more services for economic reasons.