Defensive Medicine and How It Affects Healthcare Costs

Defensive medicine is the situation in which a doctor practices medicine, either through diagnosis or treatment, not to help the patient, but rather to prevent legal action (a malpractice suit) if a problem occurs. The doctor goes beyond what is usually necessary for diagnosing and treating the patient so they can ensure they are not missing any unlikely but possible condition. They may perform procedures that the patient wants or expects even if they aren't clinically necessary, to keep the patient satisfied. For these reasons, defensive medicine is said to lead to overtesting and overtreatment. They want to prevent bad outcomes (however unlikely) and to prevent having an angry patient.

There is some data to suggest ordering more tests may reduce law suits. A study published in The British Medical Journal in 2015 looked at a large number of of physicians practicing medicine in Florida from 2000-2009. They found the doctors who ordered the most tests in any given year were substantially less likely to be sued in the following year.

Another aspect of defensive medicine is when a physician or medical practice avoids treating high-risk patients. They cherry-pick patients who are more likely to have good outcomes, or they choose a medical specialty that has less risk of malpractice suits. This can result in the most talented doctors not treating the patients who need their skills the most.

Examples of Defensive Medicine

Ordering a test a patient doesn't really need, in an effort simply to have the results show up in her records, is a defensive medicine practice used by many physicians. "Defensive medicine" is often the answer to the question, "Why does my doctor send me for so many tests?"

An emergency room physician sees a patient who had a blow to the head. Everything in the physical examination points to no indication of epidural hematoma and the doctor could discharge the patient without a CT scan. However, the very small risk that they could miss that diagnosis and end up in a lawsuit results in sending the patient for a CT scan.

Costs of Defensive Medicine

Doctors who practice in high-risk specialties are most apt to practice defensive medicine. In 2005, one survey showed as many as 93% were ordering tests, prescribing drugs, or performing procedures in more of an effort to protect themselves rather than protect the patients those measures were taken for. Legislative efforts to cap malpractice awards are one tactic proposed.

Defensive medicine is a very large contributor to the rise of healthcare costs in the United States. An analysis published in Health Affair in 2018 estimated that defensive medicine adds $25.6 billion annually. It may contribute as much as 34% of the annual healthcare costs in the United States.

Dangers of Defensive Medicine

Overtreatment with antibiotics is one example of defensive medicine that endangers everyone. A parent may expect a prescription for antibiotics when she takes her child to the doctor for a cold. The doctor knows it isn't needed, but the mother insists on getting a prescription. The doctor gives in. Now the child's normal bacteria are killed by the antibiotic, leaving only antibiotic-resistant bacteria. As this occurs, again and again, strains such as MRSA develop that are resistant to most antibiotics and can sicken and kill many patients.

Appropriate medical treatments such as watch-and-wait for some low risk, slow-growing prostate cancers may not be used because patients demand an active treatment or could sue if there is a poor outcome.

The active medical treatment (such as radical prostatectomy, radiation or hormone therapy) is not without risk of injury, death or complications such as incontinence and impotence.