Even in states with damage caps in malpractice suits, physicians are concerned about being sued, according to a new study.
Conducted by Center for Studying Health System Change and published in the September issue of Health Affairs, the study suggests that many tort reform proposals do little to deter the practice of defensive medicine, which contributes to unnecessary health spending.
"Whether justified or not, physicians' liability fears are a policy problem because defensive medicine raises healthcare costs and potentially subjects patients to unnecessary care," said Emily Carrier, MD, senior HSC researcher and co-author of the study.
Researchers said the survey was based on responses from 4,720 physicians who provide at least 20 hours per week of direct patient care.
The survey asked physicians to indicate how strongly they agreed, one a five-point scale, with the following five statements:
- I am concerned that I will be involved in a malpractice case sometime in the next 10 years.
- I feel pressured in my day-to-day practice by the threat of malpractice litigation.
- I order some tests or consultations simply to avoid the appearance of malpractice.
- Sometimes I ask for consultant opinions primarily to reduce my risk of getting sued.
- Relying on clinical judgment rather than on technology to make a diagnosis is becoming risky because of the threat of malpractice suits.
According to the study, 60 percent to 78 percent of all physicians agreed or strongly agreed with each of the five statements. Physicians agreed most strongly (78 percent) with the statement that it is becoming increasingly risky to rely on clinical judgment rather than diagnostic testing.
Researchers suggested certain kinds of payment reform may provide incentives for physicians to stop ordering widely used tests and procedures of questionable value.
"Although alterations in reimbursement policy could prove a powerful lever for reducing overuse of care, the threat of lawsuits will remain a dread risk for physicians – and will undermine reimbursement reforms – until comprehensive liability reform is adopted," the study's authors said.