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Managed Care: An Introduction
Published in A.F. Al-Assaf, Managed Care Quality, 2020
Physicians and managed care plans must address and plan around the issue of defensive medicine. Defensive medicine has been used as an excuse for adding more tests than necessary to offset the implied threat of lawsuit. It is true that the threat of litigation has altered practice behavior and increased costs, however attorneys argue that physicians need not order extra services as long as the judgment used in diagnosis and treatment is “right” and justifiable (NAMCP, 1995). This argument supports the use of practice guidelines that are based upon proven practice with documented outcome based upon statistically valid findings. The development of these practice guidelines is precluded by peer interaction.
Medical Overtesting and Racial Distrust 1
Published in Fritz Allhoff, Sandra L. Borden, Ethics and Error in Medicine, 2019
The reasons overuse occurs are hard to parse. According to some studies, defensive medicine plays some role in this—doctors feel pressure to do more than necessary to avoid liability, including testing (Greenberg and Green 2014; Mello, Chandra, Gawande, and Studdert 2010; Bishop, Federman, and Keyhani 2010). Other and more recent studies indicate that low-value care (some of which includes preventative care, such as medical tests) is driven primarily by local practices, patient expectations, or is idiosyncratic to certain diagnoses (Reid, Rabideau, and Sood 2016; Morgan et al. 2018). Medical overuse increases the cost of healthcare, puts the patients’ health at risk, and reduces the amount of time available with medical professionals for everyone (Greenberg and Green 2014; Mello, Chandra, Gawande, and Studdert 2010; Thomasian 2014). This gives us strong reasons to try to reduce medical overuse, of which overtesting is a part (Morgan et al. 2018; Mello, Chandra, Gawande, and Studdert 2010). Although awareness of medical overuse has greatly increased, practice remains largely unaffected (Morgan et al. 2015; Morgan et al. 2018).
The Problem of Rising Healthcare Costs and Spending
Published in Kant Patel, Mark Rushefsky, Healthcare Politics and Policy in America, 2019
Physicians often argue that the fear of medical malpractice suits forces them to practice defensive medicine, which in turn drives up the cost of healthcare (Seabury and Jena 2016; Thomas, Ziller, and Thayer 2012). Thus, they often argue for tort reform (Carrier et al. 2010). Practitioners of defensive medicine are physicians who, in order to protect themselves from potential malpractice lawsuits, overtreat a patient. They often overprescribe diagnostic and treatment procedures as a defense against possible malpractice lawsuits. The most commonly used definition of defensive medicine was proposed by the now-defunct Office of Technology Assessment (1994, p. 36). It defined defensive medicine as occurring when “doctors order tests, procedures, or visits, or avoid certain high-risk patients or procedures, primarily (but not solely) because of concern about malpractice liability.”
Maintaining the Punitive Element of Tort through Social Sanctions in Malpractice Reform
Published in Journal of Legal Medicine, 2018
A further concern against the current system of medical malpractice is the advent of “defensive medicine.” In fear of increasing claims and damages, physicians have begun to provide care more aggressively in a way that they may not have done so were the specter of litigation not present: increased tests, prescriptions, and procedures.8 Though surgical specialists and nonacademic practice settings have the most aggressive patterns of defensive medicine, trends for such overcautiousness are noticed across specialty types and practice settings.10 Some critics of the current malpractice system may incorrectly claim that increased litigation damages and malpractice premiums are alone to blame for growing health care costs. On the contrary, those expenses only make up about one percent of health care costs.4 When combining those costs with estimates of what U.S. physicians spend on defensive medicine, that number skyrockets to almost 10% of total health care costs.11 Such data have led many to call for sweeping reform of medical malpractice.
Medical Malpractice in Uveitis: A Review of Clinical Entities and Outcomes
Published in Ocular Immunology and Inflammation, 2018
Ashvini K. Reddy, Stephanie B. Engelhard, Christopher T. Shah, Austin J. Sim, Jennifer E. Thorne
Medical malpractice litigation is an economic pressure facing ophthalmologists in the United States. The US Department of Health and Human Services reports that Americans spend far more per capita on the costs of litigation than any other country in the world.1 A New England Journal of Medicine article analyzing malpractice risk according to physician specialty reported that physicians in surgical specialties face the greatest risk of malpractice claims2 relative to physicians in other fields. The rising frequency and severity of claims and lawsuits incurred by physicians, as well as escalating defense costs, have resulted in efforts to control physician practice risk and reduce medical errors.3 In addition, threat of litigation may affect insurance premiums4 and encourage the practice of defensive medicine as many physicians fear the frustration and expense of lawsuits. As a result of these pressures, there has been renewed interest in the incorporation of risk management principles to safeguard both patients and physicians.
Defensive medicine and its related risk factors: evidence from a sample of Iranian surgeons
Published in Hospital Practice, 2023
Abbas Daneshkohan, Faezeh Ashtar-Nakhaei, Alireza Zali, Edris Kakemam, Ehsan Zarei
Defensive medicine has negative consequences for the patient, the physician, and the health system, including increased length of hospital stay, increased costs of care, damage to the physician-patient relationship, unnecessary use of scarce healthcare resources, and the inability of other patients to receive health care [4,15–19]. DM-related behaviors may also jeopardize patient safety. For example, the unnecessary use of MRI, CT scan, and other invasive and noninvasive interventions by exposing patients to radiation or infections can be dangerous for their health.