Clinicians are increasingly performing “defensive medicine,” according to results of a recent survey (Arch Intern Med. 2010;170:1081-1083). The survey asked more than 1,200 physicians in various fields whether they believe that they “order more lab tests and procedures than patients need in order to protect themselves from malpractice suits.” The overwhelming majority (91%) answered “yes.” The view was the same regardless of the specialty of the physician. Those surveyed included general practitioners, surgeons, specialists, and emergency department doctors. Interestingly, there was a statistically significant difference in response by the sex of the physician – 93% of male doctors agreed with the statement vs. 87% of female doctors.

Physicians were also asked whether physicians believed that “protections against unwarranted malpractice lawsuits are needed to decrease the unnecessary use of diagnostic tests.” Again, 91% of physicians agreed. The survey, however, did not ask doctors what protections they thought were necessary or what malpractice reforms they supported.

The study authors estimate that as much as $60 billion is being spent on defensive medicine. “The pervasiveness of malpractice litigation is believed to lead to defensive medical practices, whereby physicians order tests or procedures in excess of their actual need to protect themselves from the risk of lawsuits,” wrote the authors. “Malpractice concerns could have an impact on health care reform efforts to improve efficiency and quality in health care, such as the promotion of the use of comparative effectiveness data, if physicians believe that following comparative effectiveness-based guidelines leaves them vulnerable to malpractice suits.”

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