Physicians’ Attitudes toward Defensive Medicine
By Edward McEachern

Often missing in the ongoing discussion of how to improve health care delivery in the U.S. is critical focus on the effect of defensive medicine on doctors and patients. Both residents and experienced physicians often complain of spending too much of their time ordering tests and administering medical procedures aimed at defending themselves from potential litigation.  

Recently, a medical resident commented on a popular physician blog:  “We no longer take the time to listen to our patients.  Instead, we have started clicking as many buttons on the computer order set as we possibly can in order to cover every life-threatening diagnosis.  But even in the world of technology, numbers, and images, medicine remains an imperfect science.”  (See “Defensive medicine forces residents to use test oriented care”: http://www.kevinmd.com/blog/2010/07/defensive-medicine-forces-residents-test-oriented-care.html.

While it’s always advisable to provide medical treatment that meets the highest standards of care, being overly concerned about potential litigation reflects time-consuming and costly expenditure of energy that could be better channeled in other directions, according to Richard Jackson, CEO of Jackson Healthcare. 

Jackson Healthcare (parent company of Jackson & Coker) has taken significant steps to frame the issues surrounding defensive medicine as it impacts patients and physicians across the health care spectrum.  Over a seven-month period, Jackson Healthcare conducted a series of nationwide surveys examining both the economic and noneconomic impact of defensive medicine as it is typically practiced.  Part of the organization’s research involved commissioning a poll with Gallup to quantify the economic impact of defensive medicine.  Survey results indicated that defensive medicine drives up health care costs by an estimated 26-34 percent. 

The survey findings have been published as a short eBook entitled “A Costly Defense:  Physicians Sound Off On The High Price Of Defensive Medicine In The U.S.”  It can be accessed online at http://www.jacksonhealthcare.com/research/defensive-medicine-ebook.html. 

The publication cited the attitudes of both new and veteran medical practitioners, such as this viewpoint from an experienced doctor:  “Even though as a clinician with 25+ years of experience, seeing the same problems day in and day out, and benefitting from the feedback of seeing how the patients ultimately end up with the treatments which are brought to bear, I still order all the tests (X-ray, MRI, etc.) on every single patient so that a jury would be convinced that ‘objective’ evidence supported my clinical decisions.  This adds needless thousands of dollars to every bill, but I’ll be damned if I’m going to put my livelihood on the line.”  http://www.kevinmd.com/blog/2010/07/defensive-medicine-forces-residents-test-oriented-care.html

Certainly this doctor doesn’t mince words!

These are some of the Jackson Healthcare survey highlights set forth in “A Costly Defense…”  

• According to one survey, as many as 92% of practicing physicians maintain that defensive medicine is chiefly responsible for driving up healthcare costs. 
  
  
• 67% of doctors believe that lawsuits come between them and their patients.
  
  
• 57% contend that defensive medicine hinders their medical decision-making ability.
  
  
• 72% of survey respondents attest that defensive medicine negatively affects patient care. 
  
  
• Defensive medicine occurs most often among primary medicine doctors, in the ER or surgical suites, especially among OB/GYN doctors who are driven to perform more C-sections. 
  
  
• Younger doctors and female physicians are more risk-aversive and tend to practice defensive medicine more than their counterparts.  
  
  
• Because of defensive medicine, some patients are over-treated and some under-treated, even when life-threatening illnesses occur. 
  
  
• Annual costs associated with defensive medicine range between $650 - 850 billion.
  
  
• Basically, $1 out of every $4 spent on health care is associated with procedures and tests ordered by doctors who are concerned about defensive medicine.
  
  
• Too often, doctors perform “rule-out medicine” rather than “diagnostic medicine” for fear of facing a lawsuit based on an accusation of negligence. 
  
  
• In terms of a solution, it’s necessary to go beyond “tort reform,” as evidence suggests that areas in the U.S. that have adopted tort reform often maintain a significant incidence of defensive medicine.
  
  
• Politics aside, any meaningful discussion of “reforming” health care must account for greatly reducing the cost of defensive medicine.
  

It is likely that Jackson Healthcare will provide updated information on this timely topic, which has garnered interest by the national press and will surely take on added significance as the implementation of health care reform takes shape. 

--Ed McEachern is Vice President of Marketing for Jackson & Coker.