Too Much of a Good Thing

A middle-aged woman goes into her doctor’s office, complaining of chest pains. Her doctor does a routine checkup and diagnoses her with heartburn. He prescribes some antacids, makes some dietary recommendations, and then says she’s free to go.

The woman, however, is unsatisfied. She fears it may be something worse — an impending heart attack or the early stages of breast cancer. Even though the doctor is confident in his diagnosis, the woman’s concern makes the doctor uneasy. If it later turns out she does develop breast cancer (one in eight women do), she may file a claim against him for a missed diagnosis. To protect himself from the possible lawsuit, the doctor orders a battery of additional tests: a chest radiograph to cover the possibility of heart attack and a mammogram for breast cancer.

This behavior is known as defensive medicine: doctors, afraid of being sued, order lots of extra tests and procedures to protect themselves.

To avoid being sued, doctors may order unnecessary tests, such as an MRI.

Their fear is certainly not unfounded — about two-thirds of malpractice suits end up getting dropped or dismissed. At first it may seem innocuous to play it safe and cover a few extra bases with these additional tests. But these diagnostic tests come at no small cost — a single MRI can cost over $7000.

Defensive medicine is an incredibly widespread practice. Around 80 percent of doctors admit to having ordered more tests than they thought were medically needed. The costs of all these unnecessary tests build up quickly — in 2008, they were estimated to have cost over $55 billion.

Things aren’t great on the patient side either. Of all patients who suffer legitimate injuries due to substandard medical care, only 2% actually file claims. And of that 2%, less than half of the claims actually get paid. This should come as no surprise, given that the average malpractice claim can cost over $100,000 to prosecute. Patients need an effective method to seek compensation for bad medical practice, as malpractice absolutely does happen.

So we have a system where doctors feel pressured to perform unnecessary tests to avoid lawsuits, but too few of the legitimate claims are heard. What can be done to reverse this trend?

One solution that is frequently brought up is called tort reform. Tort reform would place a limit on how much money patients can win from suing their doctors for malpractice. The logic certainly makes sense: filing cases will become less attractive, fewer claims will be made, insurance companies will save money, malpractice premiums will drop, doctors will feel safer and practice less defensive medicine and healthcare spending will go down.

Unfortunately, the data do not stack up to these predictions. Florida and Texas passed their versions of tort reform in 2003, but actually saw their healthcare spending go up. Even though Florida’s insurance companies saw their profits increase 4300% since passing the reform, that profit has not been passed onto doctors. Unless doctors see lower malpractice insurance rates, they won’t stop practicing defensive medicine, rendering the legislation pointless.

Many other solutions have been proposed, such as a Patient Compensation System that would keep doctors from being sued at all, as well as a safe-harbor solution that would protect physicians given that they adhere to certain evidence-based clinical practice guidelines. But if the example of tort reform has shown us anything, it is that the worthiness of these policies can only be judged by real-world data.

About The Author

Daniel Liu
Editor-in-Chief emeritus

Hailing from the quiet suburbs of Potomac, Maryland, Daniel is the former editor-in-chief of Innovation. He studies molecular biology at Princeton, with a particular research interest in cancer stem cell biology and the molecular pathways governing metastasis. Outside of academics, Daniel also enjoys painting and drawing in his free time.