Defensive medicine is widely practiced and may lead to higher costs, lower quality of care and less access to services, a study of Pennsylvania physicians indicated.
Researchers surveyed 824 Pennsylvania physicians in the specialties most frequently involved in litigation: emergency medicine, general surgery, neurosurgery, obstetrics and gynecology, orthopedic surgery and radiology. Ninety-three percent of the doctors reported sometimes or often engaging in defensive medicine.
The study was published in the Journal of the American Medical Association.
Practices meant to protect against oversight, such as performing extra diagnostic tests or referring patients for consult, were about twice as common as avoidance practices, such as refusing to perform certain procedures or treat certain patients.
More than 59% of all respondents said they often ordered more tests than medically indicated. (That figure was 70% among emergency physicians).
By comparison, some 32% of respondents said they had limited their practice or avoided procedures as a defensive step.
Physicians said they ordered extra tests not only out of legal concerns but also to pacify demanding patients, feel more confident in their decisions and create a paper trail indicating they had tested patients for particular conditions.
The irony is, defensive medicine can lead to more lawsuits because performing more tests and procedures exposes patients to more risks, study co-author William Sage, M.D., said.
There's also a negative side to recent efforts to promote patient-driven care. "Assertive patients do not, in the current malpractice climate, always get the right care," said Sage, a professor at the Columbia Law School in New York and director of the Project on Medical Liability in Pennsylvania.
The project funded the study with a grant from Pew Charitable Trusts.
The researchers did not calculate the added cost of defensive medicine but noted that more than 90% of respondents had ordered unnecessary tests and more than 60% of specialists, excluding only neurosurgeons, had performed or requested unnecessary procedures, such as biopsies.
"Ultimately, this practice drives up the cost of healthcare and contributes to the high premiums everyone pays," Pennsylvania Medical Society President William W. Lander, M.D., said in a news release.
Researchers said the high degree of avoidance behavior indicated defensive medicine not only raises costs but also limits access to services.
The effect is particularly strong on women. Some 46% of obstetricians and gynecologists reported reducing their obstetric practices, while 54% of radiologists said they avoided interpreting mammograms.
"That doesn't surprise me at all," said Chuck Moran, spokesman for the Pennsylvania Medical Society, speaking about the survey results in general. "It reinforces what we've been saying: That there's a problem out there and we need to solve it."