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Dr. Richard Anderson, CEO of TDC, on the Medical Liability Insurance Landscape.

By Richard E. Anderson MD, CEO and Chairman of The Doctors Company, the nation’s largest physician-owned medical malpractice insurer to Defensive Medicine


The 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 7 of our State of Defensive Medicine series, we asked Dr. Anderson how the medical liability insurance landscape has changed over the last 15 years. We asked Dr. Anderson questions on many different topics:
  1. Defining “Defensive Medicine” and why it’s a violation of the doctor/patient relationship.
  2. How should physicians handle patients requesting unnecessary tests?
  3. The BMJ study: Physician spending and subsequent risk of malpractice claims: observational study
  4. Alternative dispute resolution systems.
  5. MICRA’s most effective provisions.
  6. Is further tort reform necessary?
  7. The current state of the medical liability insurance landscape.
  8. Watch the full interview with Dr. Anderson.
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Mike Matray: How has the medical liability of landscape and the practice of defensive medicine changed in the last 15 plus year since your article, Billions for Defense: The Pervasive Nature of Defensive Medicine was published?

Dr. Anderson: Well, in my mind it hasn’t change one bit. And the reason I say that is that I believe that defensive medicine…and I believe that virtually every physician in the United States will tell you the same thing. It’s one of the ironies about defensive medicine. The people who practice medicine tell you they practice defensive medicine. They don’t hide it. They don’t say, “No not me.” They don’t say, “Defensive medicine? What are you talking about?” No, all of us to a man or a woman say that defensive medicine is pervasive. And yet, society chooses to continue to debate whether or not it exists. It’s really a very strange notion.

So I wouldn’t change anything that I said 15 years ago, and I do believe that even today’ tort reforms don’t affect defensive medicine much and the reason I believe that is that physicians’ aversion to the current medical system is so strong that even if you say, “Well, claims are only half as frequent as they were a decade ago, so why are you still practicing defensive medicine?” It’s because half as frequent is still way too high. And doctors don’t perceive…put it another way, the risk is way above threshold for the way most physicians practice.

Best example that I can give is in that British medical journal article that you referred to earlier. They make the point, a very interesting one, about how high the incidence of defensive medicine is in a number of first world countries. Countries that we wouldn’t necessarily…we think of England as having a very low rate of litigation. A country like Italy, we hardly think of the medical legal system. Austria, we hardly think of the medical legal system. And yet, to cite three examples from their paper, doctors in those countries will tell you about 95% of the doctors in those countries will tell you that they practice defensive medicine.

So what is my point? Well, the frequency of litigation in those countries is only about half of what it is in the United States today. So if they’re practicing 95% defensive medicine with half of today’s frequency, we are going to have to get claims down way, way further before physicians will back away from the notion of the need to practice defensive medicine.

Mike Matray: Okay, that opens it up to the big question is how do we change this? If so how do you recommend the physicians and the medical liability community get involved in order to change this defensive medicine culture.

Dr. Anderson: Yeah, I think that there are a number of things. There are some…especially society initiatives that are based on thoughtful ordering of studies and all of that is commendable. To sort of develop that medical consensus on what studies are necessary under what circumstances and to really disseminate the view that shepherding resources is an important part of physician professionalism, and that we have to be thoughtful about the way we do these studies. And certainly there are more academic studies being done that are evaluating the utility of things that we used to do routinely believing that they were effective and finding out that, in fact, they are not as effective as we thought. So I think that there is a new emphasis on professional education and all of those kinds of thing can help.

But the truth is I don’t believe that this change can really be effectuated from within medicine itself. It’s going to take cultural change. It’s going to take a change where the first American reflex whenever any of us experience adversity whether it’s medical, whether it’s a slip and fall in the street, whether it’s a bump in the supermarket, whose fault is it and who can I sue? And until we change the mindset that I’m leaving money on the table if I don’t sue somebody, then I don’t see a really profound shift. In other words, as important as I believe solving the problem of defensive medicine is, and I do believe it’s fundamental, I don’t have a magic bullet solution to it. I wish I did.

Mike: Well, Dr. Anderson it was an absolutely fascinating discussion and thank you for coming on Healthcare Matters, and I hope to talk to you again in the future.

Dr. Anderson: Well, thank you very much. It was a great pleasure. Thank you.