THE MYTH OF "DEFENSIVE MEDICINE"
“Defensive medicine” is a term made up by the U.S. Chamber of Commerce to promote the agenda of insurance companies and powerful corporations at the expense of consumers whose only recourse to justice is our jury system. Apparently, as goes the myth, doctors routinely order tests, knowing they are unnecessary, for the sole purpose of protecting themselves from frivolous malpractice suits.
$Billions For Unnecessary Tests
One Florida tort reforming emergency room doctor recently bragged that he orders $50,000 worth of unnecessary tests -- per shift! And that in a state with severe caps on damages. Assuming at that hospital two doctors per shift and three shifts, that would be over $2 million per week and $100 million per year of unnecessary tests. And where does all that Medicare and insurance money go? Right to the bottom line of the hospital. Come to think of it, if a hospital allows $100 million of knowingly unnecessary tests per year, isn’t that Medicare fraud? And that’s just one hospital. If the U.S. Chamber is right and doctors are ordering $50 billion, $200 billion, or $1 trillion of knowingly unnecessary tests annually, someone is making an awful lot of money off of those tests.
Financial Gain, Not Fear of Being Sued
The “fear of lawsuits” myth is totally discredited by the fact that those unnecessary tests are ordered most frequently in California, Texas and Michigan, all of which have draconian tort “reform” laws, and least commonly in Hawaii, which has no tort reform. Indeed, Hawaii has the lowest per capita Medicare reimbursement rate, while Texas, California and Michigan are among the highest. So, those states with the most severe restrictions on a catastrophically injured person’s access to justice also have the highest healthcare costs. Go figure.
As The New Yorker magazine eloquently demonstrated in its June 2009 issue, unnecessary tests and procedures are driven by profit motivation, not a fear of being sued. It is a change in mindset from helping patients to helping your bottom line. As The New Yorker article notes, in McAllen, Texas, one of the nation's most expensive healthcare markets (in a state with the most severe tort "reform"), a doctor explains: “Before, it was about how to do a good job. Now it is about: How much will you benefit?”
According to The New Yorker, healthcare costs increase in direct proportion to the number of individual decisions doctors make regarding which services and treatments to order. The most expensive piece of medical equipment, as the saying goes, is a doctor’s pen. (The New Yorker, "The Cost Conundrum," p. 6). Financial gain drives the demand for tests, not so-called defensive medicine.
Fortunately, not all hospitals function like those in McAllen, Texas, where malpractice suits are virtually non-existent because of caps. The Mayo Clinic and other not-for-profit institutions have eliminated financial incentives so that a doctor’s goal in patient care is not to increase his income but to do what is best for the patient. The result – fewer unncessary and expensive procedures and lower costs. In fact, healthcare costs at the Mayo Clinic are half of what they are in McAllen, Texas. And there are no caps in Minnesota.
Just What is "Unneccessary"?
Although the tort reformers would have you think otherwise, not all tests which turn out normal are unnecessary. If you fall down and hit your head and have an excruciating headache, the worst of your life, would you be satisfied if an emergency room doctor tells you to take two aspirin and go home, without any testing? And if they do a CT and it turns out you don’t have a brain hemmorrhage, was that CT unnecessary? Or if you have horrible chest pains, how would you feel if a doctor tells you he thinks it is indigestion and doesn’t do an EKG or any laboratory tests? And if they perform an EKG and it is normal, is that defensive medicine? Was your screening colonoscopy or pap smear which turned out normal, unnecessary?
Think about this. You wear your seatbelt every day and 99.9 percent of the time you don’t need it. Unnecessary? Almost all airbags go unused. Unnecessary? I, for one, think airbags, seatbelts, pap smears, colonoscopies, EKG’s for chest pain, and CT’s for excruciating headaches are not unnecessary, even when it turns out in hindsight you didn’t need them.
Give Good Doctors the Credit They Deserve
Let’s give doctors more credit than they are getting. Reputable doctors don’t order tests they know are unnecessary – for any reason. Remember, like “death panels,” defensive medicine is a myth.