Fear of Lawsuits May Be Leading to Extra Medical Tests

TUESDAY Feb. 15, 2011 -- Medical imaging tests are often ordered by doctors to protect themselves against a lawsuit, a new study suggests.

The finding stems from a survey of 72 orthopedic surgeons in Pennsylvania, who were asked about imaging tests conducted on 2,068 patients. The researchers found that 19 percent of the tests were ordered for what they called "defensive purposes" and accounted for about 35 percent of the patients' total imaging charges ($113,369 of $325,309).

The most commonly ordered tests, the study found, were MRIs, which are more costly than X-rays.

The findings were to be presented Tuesday in San Diego at the annual meeting of the American Academy of Orthopaedic Surgeons. Experts note that research presented at meetings has not been subjected to the same rigorous scrutiny given to research published in medical journals.

"This is the first study we know of that looked at the actual practice decisions of physicians regarding defensive imaging in real time -- prospectively done," Dr. John Flynn, associate chief of orthopedic surgery at Children's Hospital of Philadelphia, said in a news release from the academy.

He noted that many lawsuits hinge on the plaintiff's lawyer's claim that the doctor should have ordered extra diagnostic testing.

"And such a claim may be the driving force of so much of the defensive test ordering," Flynn said.

He said he was surprised to find that orthopedic surgeons were more likely to take defensive measures if they had been in practice for more than 15 years.

"This was counterintuitive," Flynn said. "I thought that young doctors would come out of medical school immediately after training, be less confident because they weren't experienced and order more defensive tests. Then, as they became more comfortable and confident after 10 or 20 years in practice, they would order many fewer tests. In fact, the opposite was true."

"We found that -- in Pennsylvania at least -- a surgeon's defensive nature gets worse over time," Flynn said. "In this legal environment, orthopedic surgeons order more imaging tests of a defensive nature because, over time, they become more concerned that someone is going to second-guess or sue them."

Flynn suggested that expanding the survey to other medical specialties, such as obstetrics/gynecology, neurosurgery and emergency medicine, would give a more complete picture of "how much of our nation's healthcare resources are wasted on defensive medicine."

More information

The U.S. National Institutes of Health has more about diagnostic imaging.

Posted: February 2011


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