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Malpractice Fears Can Influence Medical Practice
Date:4/13/2010

Peer pressure also plays a role, study shows

TUESDAY, April 13 (HealthDay News) -- Peer pressure and fear of malpractice lawsuits seem to be behind the decisions by some doctors to order unnecessary cardiac catheterizations, new research suggests.

When asked in a national survey why they might order this potentially hazardous procedure that measures blood flow to the human heart, even when it might not be called for clinically, the top two reasons that cardiologists around the country gave were the fact that other doctors do it routinely and that patients might sue if the test wasn't done.

"We didn't say unnecessary," noted study author Frances Lee Lucas, an epidemiologist with the Maine Medical Center in Portland, whose report was published in the April 13 online edition of Circulation: Cardiovascular Quality and Outcomes. "We said how often for non-clinical reasons. We didn't want to say unnecessary because we knew nobody would ever say they ordered an unnecessary test."

The study of 598 cardiologists didn't attempt to determine the number of catheterizations performed that weren't really needed -- an important issue in an era of rising worry about medical costs. That would be a very difficult study to do, and it would have to include errors in both directions, people who need one and don't get it as well as people who get one and don't need it, Lucas said.

Instead, they were just asked what outside factor might put them over the edge if they thought that a catheterization wasn't really essential.

Fewer than 1 percent of those responding said that the added income from doing the procedure might be a motive, a low number that didn't surprise Lucas. "I was astonished that anyone said it, but a few did," she said.

One leading reason turned out to be fear of malpractice suits, which was cited by nearly 24 percent of the cardiologists. That response varied when the answers were bro
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