Defensive Medicine

The Malpractice Myth: Republicans and Doctors offer no solutions

By Bernd Wollschlaeger,MD,FAAFP,FASAM


In a recent American Medical News article, “GOP state gains expected to have broad impact on physicians,” November 15, 2010, the author points out that the substantial GOP electoral gains could affect physicians and the health system. Medical liability reform legislation probably will receive a boost from the GOP victories, said Mark A. Peterson, a professor of public policy and political science at the University of California Los Angeles. For example, Alabama Gov.-elect Robert Bentley, MD, and Florida Gov.-elect Rick Scott -- founder of urgent-care chain Solantic -- campaigned on expanding tort reform for physicians and other health professionals. Both were endorsed by their respective state medical associations. "A central feature of Republican health care policy ... has been the notion that a major driver of costs has been malpractice" lawsuits, Peterson said. Subsequently, physicians are loudly repeating the myth that defensive medicine increases healthcare costs by up to 30% and that malpractice reform will stop and even reverse the cost increase. Rep. Tom Price (R-GA), a physician, said recently on the House Republican website America Speaking Out that “ any credible attempt to rein in the cost of health care must include a plan to address the whole issue of the practice of defensive medicine. It is estimated to cost an astounding $650 billion each year. That’s 26% of all money spent on health care. Defensive medicine does not raise the quality of care, only the cost.”

There is only one big problem: the political pundits within organized medicine are unable to provide any evidence to support their argument!

In a series of articles published in the September 2010 issue of Health Affairs the authors reached the following conclusions:



* Defensive medicine includes tests and procedures ordered by physicians principally to reduce perceived threats of medical malpractice liability. The practice is commonly assumed to increase health care costs. The results of studies of the costs of defensive medicine have been inconsistent. We found that estimated savings resulting from a 10 percent decline in medical malpractice premiums would be less than 1 percent of total medical care costs in every specialty. These savings are lower than most previous estimates, and they suggest that the presumed impact of tort reform on health care costs may be overstated.
* Physicians contend that the threat of malpractice lawsuits forces them to practice defensive medicine, which in turn raises the cost of health care. This argument underlies efforts to change malpractice laws through legislative tort reform. We evaluated physicians’ perceptions about malpractice claims in states where more objective indicators of malpractice risk, such as malpractice premiums, varied considerably. We found high levels of malpractice concern among both generalists and specialists in states where objective measures of malpractice risk were low. We also found relatively modest differences in physicians’ concerns across states with and without common tort reforms. These results suggest that many policies aimed at controlling malpractice costs may have a limited effect on physicians’ malpractice concerns.
* Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending.


Notwithstanding all of the above quoted FACTS politicians and their physicians allies still place their bets on malpractice reform.

But we all could start reforming the system TODAY if we would firmly commit ourselves to practice DEFENSIBLE MEDICINE instead. What does that mean?



1. Following expert guidelines and recommendations in managing and treating patients.
2. Implementing patient safety measures to reduce deadly medical errors killing more than 100,000 Americans every year.
3. Collaborating medical care in teams comprised of ALL health care professionals including physicians, physician assistants and ARNPs.
4. Moving from physician centered to patient centered medicine
5. Integrating health information technology into our offices and learn to share medical information.



Even Tom Price (R-GA) admits that we need to “ adopt a set of best-practice guidelines for treatment – agreed to by physicians, not bureaucrats – to provide an affirmative legal defense.”

What are we waiting for? Lets start practicing defensible medicine today.



Yours truly,



Bernd