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Health care spending: Study shows high imaging costs for defensive purposes
Date:2/15/2011

to order additional tests has an effect on patients too, in a way that involves more than costs. "Patients are sometimes put through tests that maybe otherwise would not be ordered."

The finding from this research that surprised Flynn the most was that surgeons were more likely to practice defensively if they had been in practice for more than 15 years.

"This was counterintuitive," he says. "I thought that young doctors would come out of medical school immediately after training, be less confident because they weren't experienced, and order more defensive tests. Then, as they become more comfortable and confident after 10 or 20 years in practice, they would order many fewer tests."

"In fact, the opposite was true. We found that in Pennsylvania at least a surgeon's defensive nature gets worse over time. In this legal environment, orthopaedic surgeons order more imaging tests of a defensive nature, because over time they become more concerned that someone is going to second guess or sue them."

Flynn says that medical liability awards typically are given because of the severity of a bad outcome, and not necessarily because of negligence. In fact, a May 2006 study published in the New England Journal of Medicine (Studdert DM) showed that 37 percent of claims did not involve medical errors, and in 3 percent of claims, no injury occurred at all.

Flynn pointed to various studies that show that defensive medicine, in general, is quite prevalent. One such study in the June 2005 Journal of the American Medical Association (Studdert DM) reported that almost 93 percent of 824 physicians in Pennsylvania responding to a survey practiced defensive medicine.

"Ideally, as a next step, we would hope to try to get a broader national picture using this prospective practice audit methodology, so we could get a better sense of the true costs of defensive imaging in orthopaedics," says Flynn.

"Ultimately, if you ha
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Contact: Lauren Pearson
pearson@aaos.org
847-384-4031
American Academy of Orthopaedic Surgeons
Source:Eurekalert

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