Only 12 percent of the cardiologists listed fear of malpractice in the regions of lowest intensity, compared to 35 percent in the highest-intensity regions.
About 27 percent of the cardiologists said they would do the procedure because of peer pressure, a number that varied unpredictably, from 20 percent in some regions to 35 percent in others, Lucas said.
But unlike the fear of malpractice, the effect of peer pressure did not rise in step with the intensity of treatment, Lucas said. "It isn't a nice, neat gradation," she said. "It bounces around a lot more."
The study won't help anyone who wants to point to one region of the country as a hotbed of unnecessary procedures, Lucas noted. It looked at data from 306 hospital referral regions, which could show a lot of variability in the larger, conventional geographical designations.
"Maine is very conservative, New York is very high-intensity," Lucas said. "So saying northeast isn't a very good tool."
Changing current rules on malpractice might help relieve the pressure on medical costs, the report concluded, but it didn't say what kind of change might be beneficial. Malpractice was specifically not mentioned in the health-care bill just signed into law by President Barack Obama, despite requests by medical organizations for more limits on what lawsuits physicians might face.
The American Heart Association has not taken a position on malpractice reform, said Dr. Clyde W. Yancy, president of the association and medical director of the Baylor Heart and Vascular Institute in Dallas, because "the association's prime concern is the quality of patient care and research."
The findings should be interpreted with caution, Yancy noted, because they were based on responses to proposed medical scenarios by a relatively small numb
All rights reserved