Defensive medicine under attack

Around one-eighth of all requests for tests and procedures by gastroenterologists are attributable to the practice of defensive medicine, Italian research shows.

The authors say that the rapid increase in malpractice and negligence lawsuits in recent years has led to the widespread practice of defensive medicine, in which physicians make clinical decisions in order to avoid litigation, and which are not necessarily in the best interests of the patient.

Indeed, 93.8% of the 64 gastroenterologists questioned in the study admitted to the behavior, with two (3.1%) even saying it was the only criteria they used to make decisions in daily practice.

"[Our results] clearly show that [defensive medicine] is now a well established way of thinking in the decision making process of gastroenterologists, and that it represents a significant cost that could prove to be a very heavy burden in the currently critical economic situation," say Luca Elli (University of Milan) and colleagues.

On average, gastroenterologists requested 8.9 defensive procedures per month, including colonoscopies, endoscopies, imaging, and consultations. Additionally, they reported performing an average of 76.5 procedures per month as a result of the referring physicians performing defensive medicine.

The authors estimate that defensive medicine accounted for 11% of monthly costs for procedures and that, when costs for requests and procedures performed were combined, the average monthly cost of defensive medicine was € 4234 (US$ 5684) per gastroenterologist.

There was no association between a defensive approach and factors such as age, gender, experience, level of specialization, or type of employment contract.

However, there was a significant correlation between physician-reported anxiety over legal claims and the number of defensive-procedure requests, with half of the respondents reporting that they had moved to a more defensive practice over recent years because of anxiety over litigation.

The authors also suggest that physicians felt unsupported by their hospital, with 30% reporting practicing defensive medicine for fear of litigation by both patients and their employer.

Writing in Digestive and Liver Disease, Elli and colleagues say that there has been a 148% increase in the number of medical lawsuits since 1994 in the Lombardy region of Italy where they conducted their study. However, defensive medicine can have a negative, and even dangerous, impact on patient care and has also led to rapidly escalating healthcare insurance premiums, they explain.

The team concludes that urgent action is needed to rectify the situation, given the current financial climate: "The economic burden of [defensive medicine] on the public healthcare system revealed by this study could provide a substantial stimulus for a prompt review of this situation in a time of economic crisis."

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