Defining “Defensive Medicine” and why it’s a violation of the doctor/patient relationship.
DescriptionThe State of Defensive Medicine Our guest on Healthcare Matters is Richard E. Anderson MD, CEO and Chairman of The Doctors Company, the nation’s largest physician-owned medical malpractice insurer. In part 1 of our State of Defensive Medicine series, we asked Dr. Anderson to define the term "Defensive Medicine" and tell us why he thinks it's a clear violation of the doctor/patient relationship. We asked Dr. Anderson questions on many different topics:
- Defining “Defensive Medicine” and why it’s a violation of the doctor/patient relationship.
- How should physicians handle patients requesting unnecessary tests?
- The BMJ Study: Physician spending and subsequent risk of malpractice claims: observational study
- Alternative dispute resolution systems.
- MICRA’s most effective provisions.
- Is further tort reform necessary?
- The current state of the medical liability insurance landscape.
- Watch the full interview with Dr. Anderson.
Mike Matray: Hello, and welcome to Healthcare Matters, the internet television program that explores the intersection of Medicine and the Law. I’m your host Mike Matray and today’s guest is Dr. Richard Anderson. Dr. Anderson is chairman and chief executive officer of the Doctors Company, the nation’s largest physician-owned medical malpractice insurer. Dr. Anderson was a clinical professor of medicine at the University of California San Diego and is the past chairman of the Department of Medicine at Scripps Memorial Hospital where he served as a Senior Oncologist for 18 years. Welcome to the program Dr. Anderson.
Dr. Anderson: Thank you very much. Nice to be here.
Mike Matray: I’ve had the privilege of attending a session that you delivered at the most recent PIAA Medical Liability conference on Defensive Medicine and Healthcare Transformations in the United States. You’ve written at length over the years about the negative impact of defensive medicine. You wrote an article on 1999 titled Billions for Defense: The Pervasive Nature of Defensive Medicine. And I understand you recently wrote a similar article on the topic. I would like to start by asking for your definition of Defensive Medicine.
Dr. Anderson: My definition of defensive medicine is actually a very simple one and that is simply a test, procedure, or therapy that is ordered by the physician primarily to protect himself or herself from liability rather than because of its diagnostic or therapeutic utility.
Mike Matray: Okay. What do you consider the economic dollars and cents cost of defensive medicine in the United States and what is the cost exacted by the defensive medicine on the physician-patient relationship in particular?
Dr. Anderson: Yeah, those are actually two great questions. So let me start with the first one. The cost of defensive medicine in the United States has been variously estimated at $55 to $60 billion and as high as $300 billion, but I personally, strongly believe that even the high figures grossly underestimate the real cost. Because I would argue that virtually all medicine in the United States today is defensive or that at least defensive considerations enter into clinical decision making so that…and during this course of this discussion I’m sure that we’ll have the opportunity to expand a little bit on that point. But, generally, my feeling is that almost all clinical decision making is to some degree now contaminated by defensive medicine. The cost to the healthcare system in my judgment quite seriously is almost incalculable. And I truly believe that we will not be able to significantly bend that cluster until and unless we genuinely take measures to reduce defensive medicine in the United States.
Your second question is also a very interesting question, and I think it’s a very important one. And I think it’s not asked often enough and, again, I think it’s an important calculation in the damage of defensive medicine. To some degree, defensive medicine is really a violation of the doctor-patient relationship. I, as a physician, understand defensive medicine. I practice defensive medicine. The vast majority of physicians in the United States and indeed the vast majority of physicians around the world, interestingly enough, will tell you that they practice defensive medicine. And yet, it is to some degree a violation of the doctor-patient relationship.
Now, why do I say that? Physicians should be the advocate for the patient. The doctor should not be ordering tests that he or she doesn’t really believe are primarily to benefit or have the potential to benefit the patient. One of the most important factors I think to understand about defensive medicine and it’s why the question that you asked about the definition is an important one.
My definition for defensive medicine is really a straightforward one. And therefore, you cannot distort the notion of defensive medicine into being careful medicine or being thorough medicine. Careful and thorough medical practice are good. They are by definition appropriate. And by definition they are not defensive. So that all defensive medicine is wasteful and into that extent all defensive medicine is an intrusion on the best aspects of a good doctor-patient relationship.