What About Defensive Medicine?

Lately, there has been a lot of talk about doctors practicing "defensive medicine" as a result of the "litigation crisis" in America. But, like many aspects of tort reform, many people don't know what defensive medicine is.

Defensive medicine is when a doctor, afraid of being sued, leaves no stone unturned to diagnose, treat, or cure a patient. The most common example cited is when a doctor "knows" that a patient has illness X, but runs a test to check for illness Y, just on the incredibly rare chance that the patient has illness Y. A wide variety of statistics are available to show just how much money is spent on these unnecessary tests and procedures. However, there is one statistic I'd like to see but haven't: How many lives have been saved because an "unnecessary" test diagnosed a fatal illness early?

Somehow, tort reformers argue, that because a doctor in Duluth orders an "unnecesary" MRI, patients in Los Angeles will pay more for their needed MRI's. Proponents of the defensive medicine theory therefore argue that the traditional economic principal that as supplies increase, prices decrease, somehow does not apply to medicine.

Finally, ask yourself who defensive medicine really hurts. It doesn't hurt the doctor that charges for the procedure or test. It doesn't hurt the pharmaceutical that supplies drugs for the procedure or test. It certainly doesn't hurt the patient to have an extremely thorough doctor. And if the patient is footing the bill, he or she can certainly choose whether or not to have the procedure or test done.

The only other party that defensive medicine could possibly hurt would be insurance companies.  But the problem with that theory is that insurance companies have very strict policies about what procedures and tests they'll pay for.  It's all too common for a patient to develop a serious medical condition because their insurer wouldn't pay for a test or procedure that would have diagnosed the condition before it became serious.

So defensive medicine puts money in the pockets of doctors, hospitals, and pharmaceuticals.  Insurance companies won't pay for defensive medicine, so it doesn't raise anyone's health insurance premiums.  From time to time, defensive medicine saves lives.  It would therefore appear that "defensive medicine" is just another sham used to scare people into supporting tort reform.

Comments

[Kim Niebling]

As someone who used to work in a presurgical testing center, I can tell you that there were times when a patient had tests for a surgical procedure that revealed another, unrelated health problem. It used to be routine that if you were going under general anesthesia, you had a chest xray and an EKG along with some blood work. Now, because insurance companies are dictating medicine, xrays and EKGs are not administered (routine) unless there is an indication that they are needed (if you are below a certain age, ie 40). I can tell you there were times when seemingly young, healthy patients had underlying conditions that would not have been discovered unless they had these tests. I remember one patient in particular who was in her early 30's who had an undetected heart problem. That's the kind of thing you want to know BEFORE you go under anesthesia. I also remember a young woman, nonsmoking, who's chest xray revealed a tumor, although she didn't have any symptoms yet. I think of those patients who will have complications from surgeries or will not be diagnosed with life threatening illnesses in order to cut costs. Particularly if they are young. Anyway, just thought I'd share a piece of my healthcare experience. Oh, the stories I could tell...

"Somehow, tort reformers argue, that because a doctor in Duluth orders an "unnecesary" MRI, patients in Los Angeles will pay more for their needed MRI's. Proponents of the defensive medicine theory therefore argue that the traditional economic principal that as supplies increase, prices decrease, somehow does not apply to medicine."

I think you've got that backward in the example, or insufficiently explained. By ordering "unnecessary" MRI's a doctor would be increasing demand. Supply might eventually increase because of the demand, but price would likely rise in the process.

Also, your strawman attack on increasing demand in a different part of the country is really a transparently stupid trick, stick to legitimate points it increases your credibility.

There should be a happy medium between administering truly unnecessary tests and not administering tests that might be vitally important.

Sure, insurance companies do interfere greatly with patient care, making decisions on allowable procedures and therapies instead of leaving critical decisions to physicians. But to overlook the obvious threat of litigation that looms over any person that practices medicine would be unwise. In my experience, I don't know any other physician who hasn't been forced to perform additional tests, often due to pressure from hospital legal teams, in order to "cover all bases" prior to making a final diagnosis. As written in a previous entry, your supply and demand explanation is shaky at least, and increased costs passed on to insurance companies surely do get passed on to existing and future policy prices.

To quote: "And if the patient is footing the bill, he or she can certainly choose whether or not to have the procedure or test done."

You've been told you're healthy but there's a chance you could have a tumor, and there's a test that can tell you for sure. Do you want the test?

Is that really considered a "choice" situation?

Is there any chance that choice could be influenced by the level of importance the doctor gives the procedure? And how likely is the patient to know whether or not the doctor truly thinks the procedure is necessary?