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Defensive medicine widespread among OBs
David M. Studdert, LLB, ScD, MPH, of the Harvard School of Public Health, Boston, and colleagues have conducted a study to determine whether volatile malpractice-insurance markets induce defensive defensive practices among physicians. In May 2003, the researchers surveyed Pennsylvania physician in six specialties at high risk of malpractice claims, including obstetrics/gynecology, about the frequency and nature of their defensive practices. |
A total of 824 physicians (65 percent) competed the survey. Ninety-three percent reported practicing defensive medicine. "Assurance behavior" such as ordering tests, performing diagnostic procedures, and referring patients for consultation was very common (92 percent). Among practitioners of defensive medicine who detailed their most recent defensive act, 43 percent reported using imaging technology in clinically unnecessary circumstances. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous three years, including eliminating procedures prone to complications and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents' lack of confidence in their malpractice insurance and perceived burden of insurance premiums.
"Higher levels of defensive medicine are part of the social costs of instability in the malpractice system. The most frequent form of defensive medicine, ordering costly imaging studies, seems merely wasteful but other defensive behaviors may reduce access to care and even pose risks of physical harm. Because both obstetrics and breast cancer detection are high-liability fields, women's health may be particularly affected," the authors write.
David M. Studdert, LLB, ScD, MPH, "Defensive Medicine among High-Risk Specialist Physicians in a Volatile Malpractice Environment," JAMA 293 (1 June 2005): 2609-2617. |
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