Defensive Medicine: Do You Practice in Fear of Lawsuit?

As nurse practitioners, we certainly practice at risk of being sued.  Between personal injury attorneys advertising on TV and the undeniable truths that everyone makes mistakes and some patients will simply never be satisfied with their care, the risk of lawsuit is real.  How does this risk affect nurse practitioners in their practice?

What is Defensive Medicine?

Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily to protect yourself from medical liability rather than ensure the health of the patient.  For example, in diagnosing a patient with right lower quadrant abdominal pain, you perform urinalysis and find a rip-roaring urinary tract infection.  Great, medical mystery solved, right?  Nope.  Although you suspect this is the cause of the patient's pain, right lower abdominal pain can signal appendicitis so you add on a CT scan of the abdomen and pelvis...just in case.

Defensive medicine takes two forms, assurance and avoidance.  Assurance behaviors work similarly to the situation described above.  They include ordering additional testing or procedures in order to reduce risk of adverse outcome.  Assurance behaviors serve to deter medical malpractice lawsuit or provide documentation of meeting a certain standard of care in case of future legal action.  Avoidance is simply the refusal to participate in high risk care situations.  For example, some providers refuse to treat obese patients.

How Much Does Defensive Medicine Cost Our Country?

All of this unnecessary testing stemming from our lawsuit-happy culture costs our county dearly.  First, there are the legal fees.  The average cost of defending a medical malpractice claim is $27,000.  The majority of these cases are dropped, withdrawn or dismissed rendering these expenditures a waste.  Overall, defending medical malpractice claims costs Americans $5 billion each year. 

Second, there is the cost of additional CT scans, MRI's, labs and potentially unnecessary procedures.  The costs of all these unnecessary tests to mitigate legal risk is astonishing.  Experts estimate that one in four healthcare dollars spent in our country can be attributed to the practice of defensive medicine totaling an astonishing $480 billion annually.

Non-Monetary Drawbacks of Defense

Economists and legislators understandably focus on the bottom-line, cost, in evaluating the problem of defensive medicine.  But, this practice has other intangible costs.  If patients receive multiple medical tests every time they visit a medical provider, they internalize this as a standard of care.  They begin to ask for more, specialized tests and as providers we often comply.  

Ordering unnecessary diagnostic tests and procedures also places our patients in danger.  Do we risk them radiation exposure and ultimately the threat of cancer to deter a medical malpractice filing?  Not to mention the risk of complication or medical error increases with each additional test and procedure preformed.

Why Do We Order so Many Tests?

The risk of getting sued is real.  No provider wants a malpractice claim filed against them.  These claims cost time, money and serious emotional stress.  61% of physicians over the age of 55 have been sued.  90% of surgeons over the age of 55 have had a malpractice claim filed against them.  51% of OB/ GYN's under the age of 40 have faced a medical lawsuit.  No wonder we alter our behaviors to address this reality.  

As a nurse practitioner, you likely integrate defensive medical tactics into your practice.  I do.  With the threat of a malpractice claim being so real, it seems foolish not to proactively prevent a lawsuit.  However, the costs of practicing defensively are contributing to the ruin of the healthcare system and harming our patients.  It's time to change our ways. 

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