Addressing Defensive Medicine

Defensive medicine has been a topic of national discussion since the healthcare reform debates dominated the news cycle in 2009 and much of 2010.

Defensive medicine is commonly referred to as the practice of ordering diagnostic tests primarily as a safeguard against medical malpractice lawsuits. These unnecessary tests are ordered primarily to both deter medical malpractice claims and, if served with a claim, to provide evidence that the physician met and/or exceeded the generally accepted standard of care when treating the injured patient.

There have been several anti-defensive medicine movements that have sprung up in recent years. The James Madison Institute released a study at the beginning of this year that advocated scrapping the traditional system for litigating medical malpractice claims in favor of a patient compensation system where malpractice claims would be reviewed by a medical review board overseen by a special administrative agency. Victims of medical malpractice would be awarded compensation by a patient compensation board. An entity akin to a quality improvement council would analyze the root causes of medical errors and establish standards for best practices. A medical licensing board would discipline those who provide substandard care, and the entire system would be funded by existing insurance premiums from all providers. The James Madison Institute’s suggested legislation was introduced for debate in the Florida legislature this year.

The most recent anti-defensive medicine initiative comes from the ABIM Foundation under the moniker “Choosing Wisely.” The Choosing Wisely initiative is focused on encouraging doctors and patients to discuss medical tests and procedures that may be unnecessary. To jumpstart these conversations, Choosing Wisely has disseminated a pamphlet titled “Five Things Physicians and Patients Should Question,” which will help usher the conversation in the direction evidence-based testing.

The Choosing Wisely campaign just released a report put together by nine leading physician specialty societies that identifies tests or procedures that are commonly used but not always necessary in their respective fields. Anti-defensive medicine advocates are calling the move a significant step toward improving the quality and safety of healthcare.

Defensive medicine is a real problem in American healthcare, and the public is just taking note. Now is the time to have the defensive medicine debate and bring together decision makers so that together we can make healthcare more affordable.

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