Doctors' Malpractice Fears Hurt Health Care
Liability Fears Trump Patient Needs for 'Staggering' Number of Docs
WebMD News Archive
May 31, 2005 -- Malpractice fears keep most doctors from treating patients the way they should, a disturbing new study shows.
How big a problem is it? Very, very big, says Peter P. Budetti, MD, JD, of the University of Oklahoma.
"A staggering percentage of doctors -- 93% of them -- acknowledge they did things they themselves regard as deviating from sound medical practice," Budetti tells WebMD. "Well, that is not what doctors are all about. They are there to treat patients."
Doctor Liability Fears Affect Patient Care
Harvard researcher David M. Studdert, LLB, ScD, MPH, and colleagues went to a state -- Pennsylvania -- in the middle of a malpractice insurance crisis. From 2000-2003, several major insurers left the state. Premiums for medical liability policies shot up.
Studdert and colleagues asked 825 doctors from the six specialties at highest risk of malpractice lawsuits -- emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology -- to answer pointed questions about how they practiced medicine.
The bottom line: 93% of the doctors say they practice "defensive medicine." It means that to protect themselves against possible malpractice lawsuits, doctors do two things. On the one hand, they may order what they feel are additional yet unnecessary tests and procedures. On the other hand, they may distance themselves from treatments -- and patients -- that might put the doctors at risk of a lawsuit.
Studdert's team found that:
- 92% of the doctors ordered tests, diagnostic procedures, or referrals for specialist consultations that they did not think were needed.
- 43% of the doctors say they ordered imaging tests they didn't think necessary.
- 42% of the doctors stopped performing procedures prone to complications (such as trauma surgery), avoided patients with complex medical problems, or avoided patients they thought might be likely to sue them.
Studdert and colleagues report their findings appear in the June 1 issue of The Journal of the American Medical Association. Budetti's editorial accompanies the study. "This rate -- 93% -- is very, very high," Budetti says. "This is a substantial documentation of the extent to which doctors feel they are pressured into doing things that are not of value to their patients."
Studdert notes that the 93% figure is based on doctors with high-liability-risk specialties in the middle of a statewide liability insurance crisis. Half of these doctors already had been sued at least once. They are not typical of the average doctor. They instead represent doctors on the cutting edge of the liability insurance issue.
Patients or Possible Plaintiffs?
"What our study suggests is that doctors' defensive postures have real impacts on patients," Studdert tells WebMD.
This, he says, comes in several forms:
- Additional services inspired by doctor defensiveness make health care more costly.
- Doctor defensiveness may lead to more difficulty in getting access to treatment for procedures seen by doctors as carrying a high lawsuit risk.
- Quality of care may decline. "Do patients get the best care if doctors are concerned about malpractice?" Studdert asks.
- Doctor/patient relationships become strained. "What does it mean to patients if their doctors are sizing them up, as it were, for their propensity to sue them? We feel that is a negative thing from a health care quality point of view," Studdert says.