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Survey: Doctors Order Imaging Tests ‘Defensively’

Some Doctors Say They Request MRIs and X-rays Because They Worry About Getting Sued

Defensive Imaging: A Closer Look continued...

And about 41% of CT scans, 56% of bone scans, and 43% of ultrasounds were ordered for defensive reasons. Under 10% of X-rays were ordered for defensive reasons.

Doctors who had experienced a lawsuit in the last five years were more apt to do defensive imaging, not surprisingly.

But so were those who had been in practice more than 15 years, Flynn found, which may reflect a growing wariness that they will be sued.

Specialists were more likely to order defensive tests. While 20.1% of imaging tests ordered by specialists were described as defensive, 16.4% of those ordered by general othopaedists were.

The study has limitations, Miller says. ''There were only about 2,000 patient encounters," he says. And only a minority of doctors completed the survey.

Mecial Testing: Cautious or Defensive?

David T. Schwartz, MD, is an attending physician at Bellevue Hospital and the Hospital for Joint Diseases and associate professor of emergency medicine at New York University School of Medicine. He has published on the topic of unnecessary testing and reviewed the study for WebMD.

"Nineteen percent is pretty high for unnecessary testing," he says. "Especially when you parse it and see that for MRI the percent is [nearly] 40%."

But, he says, there's often a fine line between defensive testing and what he calls cautious medical practice.

Private practice doctors might be especially under pressure to order tests, he says, if patients request it. "If you're in private practice [and don't order it], they'll go to someone else," he says.

"I suspect much of this overtesting is to meet patient expectations (and not just to avoid a malpractice suit)," he says.

The message for patients? Schwartz says patients should "listen to their doctors' advice on whether testing is indicated or not."

Flynn suggests having a good relationship with your doctor and, if an imaging test is about to be ordered, ask why it is needed.

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