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Greater Use of Resources vs. Defensive Medicine: What’s the Difference?

By Anupam B. Jena, MD, PhD to Defensive Medicine


Greater Use of Resources vs. Defensive Medicine: What's the Difference?

Our guest on Healthcare Matters is Anupam B. Jena, MD, PhD, one of the authors of the study Physician spending and subsequent risks of malpractice claims: an observational study, which was published in The BMJ in November 2015. Dr. Jena sat down with Healthcare Matters to discuss the study's results, methods and limitations as well as its implications for research on defensive medicine and healthcare spending. Dr. Jena details how the study shows a correlation between increases in physician spending and a lower likelihood for that physician to be subsequently sued for malpractice. Though the study has several limitations which are addressed during the interview, it helps to shed light on important aspects of healthcare spending, the doctor-patient relationship and the difference between appropriate healthcare spending and defensive medicine. In Part II of our interview, we ask Dr. Jena to discuss the difference between greater use of resources by physicians and defensive medicine. This is the second part of our interview with Dr. Jena. To see the full interview, click here. To view each portion of the interview separately, please use the links below.

  1. Does Defensive Medicine "Work"?
  2. Greater use of Resources vs. Defensive Medicine: What's the Difference?
  3. The Link between Physician Spending and Medical Malpractice Claims
  4. Medical Malpractice Claims and the Doctor-Patient Relationship
  5. Physician Spending, Patient Outcomes and Future Research
  6. How can we differentiate between defensive medicine and “good” medicine?
  7. Fee-for-Service vs. Outcome-Based Models and the Effect on Healthcare Costs
  8. Could Defensive Medicine Actually Lower Medical Malpractice Claims?
This interview is brought to you by Cunningham Group, the Medical Malpractice Insurance Specialists.


Mike Matray: Your study looked at whether a greater use of resources by a physician reduced the risk of a malpractice claim. In discussing your study with people within the medical professional liability industry, many conflated greater use of resources with defensive medicine. Is this a fair conflation, or is there a difference between greater use of resources and defensive medicine?

Dr. Jena: Yeah, no there is actually a difference. So, let me give you an example. If a malpractice environment leads a physician to order colonoscopies more appropriately than he or she had been doing before, and what you find is that cancer screening rates go up and that patient outcomes improve, we wouldn’t call that defensive medicine. That’s actually the intent of the malpractice system to get physicians to practice appropriately. Defensive medicine means something different.

Defensive medicine means additional tests and procedures that are done that actually deliver no benefit to the patient. And so to the extent that greater use of healthcare services actually improves patient outcomes, we don’t want to call that defensive medicine. It may reduce liability, but we should be specific not to call that defensive medicine. That’s actually good medicine.

Mike Matray: Okay. Your study indicated that a greater use of resources can be an effective tool to reduce the likelihood of a malpractice claim. Is this a fair statement and can you expound upon it?

Dr. Jena: That’s a great question. In our study, it’s the second. We show two things, one is that doctors who spend more after you account for differences and the types of patients that they see, doctors who spend more are less likely to get sued. The second finding is that even if you look at the same doctor over time, when a doctor spends more in those years, he or she is less likely to be subsequently sued in the following years compared to periods in their life as a practicing physician when they spend less. So in other words, we’re using the doctor as their own control to study what happens to rates of lawsuits during periods in which they spend more or less.

And the third finding of the study was that we looked at a specific clinical example of C sections. C sections have often been argued to be defensively motivated, and we know that in the United States, rates of C sections are quite high, on the order of 30% of all births. And what we found is that doctors who perform higher risk-adjusted rates of C sections are also less likely to get sued. And so all of this simply suggests that doctors who spend more and do more are less likely to get sued. But a main limitation of the study is that we couldn’t…we didn’t look at outcomes, and so it’s hard to say whether or not what we’re identifying is truly defensive medicine, or whether it’s just that this is better medicine, at least in better outcomes, and therefore lower rates of lawsuits.