The health costs of defensive medicine

by Ted Frank on March 4, 2008

There is no shortage of examples of medical malpractice litigation where plaintiffs blame doctors for failing to perform a CT scan. E.g., Oct. 2006 and Feb. 2004. This plainly raises costs far more than the direct costs of medical malpractice insurance that you see when the trial bar claims that malpractice reflects only 1-2% of health-care expenses. Tom Baker, among others, argues that defensive medicine has to be viewed as good with bad, because of improved health-care outcomes from the additional care. But not all defensive medicine is positive; it can be irrelevant, or, worse, adversely affects health results.

Malpractice litigation does change doctors’ incentives, but only with respect to short-term results. Because doctors won’t be sued for long-term consequences of defensive medicine, there is a substantial risk of overexposure to radiation in the course of defensive CT scans—a problem identified in a study in the latest issue of Annals of Emergency Medicine (Winslow, et al., Quantitative Assessment of Diagnostic Radiation Doses in Adult Blunt Trauma Patients; Reuters summary), finding that standard trauma treatment—1005 chest X-ray equivalents—results in an additional 322 cases of cancer per 100,000 treated because of use of CT scans. Earlier: Feb. 2004.

(Update: Walter writes in to note that “the problem of needless or avoidable CT and MRI scans has been getting a fair bit of discussion at the medical blogs lately, e.g. White Coat Rants, GruntDoc, and KevinMD.”)


1 OBQuiet 03.04.08 at 9:12 am

Ted, Ted, Ted,

You are clearly living in the dark ages(with all the extra RADs, things should be glowing soon).

I have a modest proposal.

The clear econimic solution is to create a balanced incentive for doctors. Simply sue them every time a CT comes back with out finding anything! Cost of long-term monitoring like all those other cases that the lawyers are finding so profitable.

This will create a proper disincentive to offset the the incentive to perform the test caused by excessive lawsuits. It will allow Doctors to once again call for tests that they feel are needed without worrying about the liability issues. They are liable either way! The patients will see better long-term outcomes, doctors are once again free to practice medicine and , best of all, the Lawyers all get paid!

2 throckmorton 03.04.08 at 9:26 am

“Defensive Medicine” is one of those terms that has its meaning swayed for the benefit of whoever is trying to prove a point. The problem is that we have no good way of knowing what is defensive or not. To determine what is defensive we have to look at what sensitivity and specificity we will accept. The classic example is a headache in the ER. With a good clinical assessemnt and time you can be sure 99% that this is a migraine. Is 99% good enough? Not in a court of law where one missed out of 1,000,000 will cause a huge lawsuit. So, you order the ct scan and expose the patient to radiation, if that is negative there is the MRI and MRA ($5600). Can we use research to determine what the exact cutoffs should be for a scan or not? Sure, this is easy to do but then how will attorneys sue for the one in a million that occurs.

“Defensive medicine” is real and represents a huge part of our outpatient studies and medical expenditure. Unfortunately our courts show us that there is no room for reason, science and statistics. Until we as a society can determine what we will and will not accept in terms of sensitivity and specificity, more and more tests and radiation will used to treat attorneys instead of patients.

3 Walter Olson 03.05.08 at 12:00 pm

It’s also worth pointing out that the problem of needless or avoidable CT and MRI scans has been getting a fair bit of discussion at the medical blogs lately, e.g. White Coat Rants, GruntDoc, and KevinMD.

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