More than 90 percent of surveyed physicians in Pennsylvania reported defensive medicine practices such as over-ordering of diagnostic tests, unnecessary referrals and avoidance of high-risk patients, according to a study in the June 1 issue of JAMA.
Defensive medicine is a deviation from sound medical practice that is induced primarily by a threat of malpractice suits, according to background information in the article. Defensive medicine has been reported widely in the United States and abroad. However, its prevalence and characteristics remain controversial.
According to the article, defensive medicine may supplement care (e.g., additional testing or treatment), replace care (e.g., referral to another physician or health facility), or reduce care (e.g., refusal to treat particular patients). Some practices, described as "assurance behavior" (sometimes called "positive" defensive medicine), involve supplying additional services of marginal or no medical value with the aim of reducing adverse outcomes, deterring patients from filing malpractice claims, or persuading the legal system that the standard of care was met. Other practices, described as "avoidance behavior" (sometimes called "negative" defensive medicine), reflect physicians' efforts to distance themselves from sources of legal risk. Defensive medicine, particularly avoidance behavior, encompasses both day-to-day clinical decisions affecting individual patients and more systematic alterations of scope and style of practice.
David M. Studdert, L.L.B., Sc.D., M.P.H., of the Harvard School of Public Health, Boston, and colleagues conducted a study to determine whether during a more volatile period in malpractice insurance markets, physicians' uncertainty about the costs and availability of coverage may induce a wider array of defensive practices, affecting not only the cost of health care but also its accessibility and quality. In May 2003, the researchers surveyed Pennsylvania physicians in six specialties at high risk of malpractice claims about the frequency and nature of their defensive practices. The specialties were emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology.