Defensive Medicine and the Need for Tort Reform-sp

Defensive Medicine and the Need for Tort Reform
Recent increases in physician malpractice premiums, along with growth in the size and number of awards to plaintiffs, have spawned numerous concerns about the medical malpractice liability system. Perhaps the greatest concern is whether these rising premiums and reprimands have altered the way physicians practice medicine. This deviation from traditional practice could lead to sacrificed patient care and inflationary medical costs. In a study of 58,441 obstetric deliveries in New York State the "costly existence of defensive medicine in obstetrics" was confirmed1. Another study showed a 2.2% increase in imaging services spending for every 10% increase in malpractice premiums3. Others cite a 1999 study which concluded that our health care system could save $50 billion per year without any compromise in outcome if tort reform laws were enacted6. In Pennsylvania, the state that pays the most for liability insurance, it was shown that defensive medicine, "is highly prevalent among physicians with potentially serious implications for cost, access, and both technical and interpersonal quality of care."2 Acknowledging defensive medicine and its potential impact on health care has caused many to demand tort reform laws that cap unnecessary, unfair, and costly malpractice awards. In 2006, 28 states had laws that limited payments in malpractice cases. It was shown that limiting these payments lowered state health care expenditures by between 3% and 4%4.
Many, however, are not impressed with defensive medicine and its role in elevating health care costs. They claim that defensive medicine has a miniscule role in escalating the costs of health care, and thus, tort reform laws that limit malpractice awards would be an unnecessary and wasteful misuse of sparse resources. According to MCARE data from 2001-2002,[url=http://peutereyoutletitalia.albirank.net/][b]http://peutereyoutletitalia.albirank.net/[/b][/url], fewer than 3% of the high-risk specialists in Pennsylvania altered the way they practice major or minor procedures2. Furthermore, no association existed between malpractice experience or exposure of individual physicians and an increase in the use of prenatal resources or cesarean deliveries for the care of low-risk obstetric patients6. In conclusion, it is obvious that many do not believe defensive medicine is aggravating an already costly health care system, and therefore are unable to support tort reform laws which cap malpractice payments.
Nationally, there are more than 17 claims for every 100 full-time practicing physicians every year and in high-risk specialties the rate is higher5. The basic theory behind the existence of defensive medicine is that physicians order unnecessary tests and procedures to escape litigation. Physicians are frightened that the National Practitioner Data Bank will emphasize every paid claim against them and that this history will follow them endlessly in each application for hospital privileges and managed care contracts. Further, now many states can document malpractice records on the internet. Numerous surveys have shown sued physicians to be more likely to report symptoms of personal stress and to consider early retirement. So,[url=http://duveticajacketsoutlet.olimx.com/][b]http://duveticajacketsoutlet.olimx.com/[/b][/url], physicians react to this fear, and this defensive reaction produces significant changes in the way physicians were trained to practice medicine which results in wasteful spending that leads to higher costs and unrecognized distortions in the provision of medical care.
Richard Anderson MD and many other physicians in the United States claim that they, "can longer define standards of care without reference to societal standards."5 This confusion and uncertainty breeds impulsive and reactionary medical practice which aggravates our costly health care system. Rates of Cesarean delivery in the United States rose from 4.5 per 100 births in 1965 to 24.1 per 100 in 19865. Is this nearly six-fold increase a result of more complicated pregnancies, or a reactionary response to an increasing fear of getting sued? Defensive medicine has become such a pervasive problem in Anderson practice that he says,[url=http://woolrichoutletdeutschland.olimx.com/][b]http://woolrichoutletdeutschland.olimx.com/[/b][/url], "medical responses are undertaken to avoid liability rather than to benefit the patient." In addition, he admits to ordering more tests, procedures,[url=http://giuseppezanottioutletonline.webmium.com/][b]giuseppe zanotti outlet online Sale[/b][/url], and visits, or avoids high-risk patients or procedures primarily to reduce the exposure to malpractice liability. Anderson and other frustrated physicians cite the Office of Technology Assessment estimate that 8% of diagnostic testing in the United States is the direct result of defensive medicine. These unfounded tests have been estimated to cost 5% to 9% of the United States health care budget. A large amount of this wasteful spending has been seen in mammography. Today, allegations involving the failure to diagnose breast cancer are one of the most common causes for malpractice suits. As a result, radiologists find themselves reading mammograms as abnormal nearly twice as common in the United States as elsewhere leading to more false positive diagnoses5. The wasted time,[url=http://merrellshoesusaonline.blogspot.com/][b]merrell shoes usa online[/b][/url], along with the fear and morbidity that comes with a false diagnosis is another cost of defensive medicine which is extremely difficult to quantify. To conclude,[url=http://woolricharcticparkauomooutlet.olimx.com/][b]http://woolricharcticparkauomooutlet.olimx.com/[/b][/url], not only has defensive medicine been shown to be financially destructive,[url=http://duveticapiuminiitalia.webmium.com/][b]Duvetica Piumini Italia Outlet Shop Duvetica Down Jackets Uomo[/b][/url], but it also can be argued that defensive medicine sacrifices patient health and peace of mind.
Few medical disciplines have been affected more by the malpractice crisis than obstetrics and gynecology. From 1982 to 1986 obstetricians saw their malpractice premiums increase by 113%. According to a 1987 survey by the American College of Obstetricians and Gynecologists, 70% of obstetricians reported that they had at least one malpractice claim filed against them1. Logically, OBGYN would seem to be an ideal specialty to study for the presence of defensive medicine. Tussing et al studied 58,[url=http://2013rogerviviershoessaks.blogspot.com/][b]Roger Vivier Boots Outlet[/b][/url],441 deliveries in New York State to test for the existence of defensive medicine. His hypothesis was that electronic fetal monitoring (EFM), which is urged widely by attorneys concerned with medical liability, would be used more often by fearful obstetricians. This excessive use would lead to greater fetal distress diagnoses which would cause a higher C-section rate. This hypothesis is supported by the US Office of Technology Assessment statement that, "the fear of malpractice could raise obstetric expenditures by influencing c-section rates."1
The results of the landmark study by Tussing et al confirmed the existence of defensive medicine in obstetrics. While controlling for all other factors, the use of EFM,[url=http://woolrichparkaschweiz.albirank.net/][b]http://woolrichparkaschweiz.albirank.net/[/b][/url], the use of the fetal distress diagnosis, and choice of C-section for delivery were all significantly increased due to the greater exposure to malpractice suits. Though the results only showed a 1.5% increase in the use of EFM due to malpractice, this was still statistically significant and is an extremely undesirable effect. Although malpractice attorneys seem to favor the use of the EFM, most of the data shows that EFM is less accurate than periodic auscultation by nurses. This results in excessive reporting of fetal distress leading to more unnecessary C-sections. It was determined that malpractice exposure raised the C-section rate by 6.6%; a substantial component of the 27.6% C-section rate in the study population. Of this effect, 4.4% was due to the direct effect of malpractice exposure on choosing Cesarean delivery and 2.2% was indirectly due to the elevated use of EFM1. The results obtained in this study are further supported by a meta-analysis of similar studies by Vintzileos et al who showed that EFM increased the C-section rate for fetal distress by 155%. It was concluded that, "if nationwide only an eighth,[url=http://giuseppezanottioutletonline.webmium.com/][b]Guseppe Zanotti Official Sale[/b][/url], rather than a quarter,[url=http://duveticacanadashop.halod.com/][b]duvetica jackets canada outlet shop duvetica down jackets online sale[/b][/url], of all C-sections could be attributed to defensive medicine,[url=http://duveticajacketsoutlet.olimx.com/][b]Duvetica Jackets Duvetica Online Duvetica Outlet Duvetica Sale Duvetica Vest Duvetica Coat Duvetica Kappa[/b][/url], the number of excess C-sections would decrease as much as 100,000 annually, at a cost of hundreds of millions of dollars."1
In order to discover whether defensive medicine exists, a logical approach would be to ask the physicians that are consistently exposed to the malpractice crisis. In 2005, Studdert et al surveyed 824 physicians in six specialties at high risk of litigation (emergency medicine, general surgery, orthopedic surgery,[url=http://giuseppezanottioutletonline.webmium.com/][b]http://giuseppezanottioutletonline.webmium.com/[/b][/url], neurosurgery, radiology, and obstetrics/gynecology) to determine if these clinicians practice defensive medicine. This study found that 92% of respondents admitted to practicing "assurance behavior", practices that involve supplying additional services of marginal or no medical value with the aim of reducing adverse outcomes, deterring patients from filing malpractice claims,[url=http://peutereyjackenherrenoutlet.albirank.net/][b]Peuterey Jacken Herren Outlet Peuterey Jacke Damen Sale Online[/b][/url], or persuading the legal system that the standard of care was met. Among the 93% of physicians that practice defensive medicine, 43% reported using imaging technology in situations that were not clinically indicated. Furthermore, 42% of respondents admitted to avoiding high-risk patients and procedures reporting that within the last three years they have taken certain steps to restrict their practice from high-risk specialties, such as trauma surgery, and have avoided highly complicated medical problems perceived as litigious7.
Further dissection of this study reveals more disenchanting facts about today clinicians. Since 1995, 88% of them had been previously sued,[url=http://peutereyjackenherrenoutlet.albirank.net/][b]http://peutereyjackenherrenoutlet.albirank.net/[/b][/url], 48% had been sued in the previous 3 years, 51% had been dropped by an insurance carrier, and 41% classified malpractice to be "extremely burdensome". It is important to realize that these 824 physicians were randomly surveyed; this was not a forum for physicians to voluntarily vent their frustrations. Even more worrisome is the fact that 59% of physicians admitted to ordering more diagnostic tests than was indicated, 52% reported referring patients unnecessarily to specialists, 33% reported prescribing unnecessary medications, and 33% reported recommending unwarranted invasive procedures. Of the excessive diagnostic testing, MRI, CT scan, and radiography were at the top of the list. Analysis of emergency physicians alone shows that 16% admit to extensive workups, including h
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