1.2 trillion U.S. dollars has been attributed to wasteful healthcare spending in the U.S. Most physicians and healthcare reformists claim that defensive medicine, where physicians order procedures and tests in order to avoid malpractice lawsuits instead of advancing patient diagnosis, is attributed to said unnecessary healthcare expenditure. The paper identified aims at quantifying the financial impact and exposure to radiation linked to a radiographic examination of trauma patients (Chen et al., 2015).
In addition to the expense defensive medicine incurs on the medical budget, the costs of superfluous imaging may potentially expose patients to harmful radiation. Is overordering radiologic procedures a form of defensive medicine? The study aimed at determining the frequency of unnecessary radiography tests on trauma patients, determining the number of substantial injuries sustained in cases deemed unnecessary, quantifying the radiation level patients are exposed to in such cases and determining the monetary effect of unnecessary radiography tests. The paper is a quantitative study using prospective observation. Surveys were used to determine the scans ordered by physicians, the possibility of injury in these scans and the number of scans that would have been requested in a neutral, lawsuit free setting. Some of the tools used in analysis include Cohen’s kappa, chart reviews and Fischer’s exact test. The study found that out of 1097 scans ordered, 416 of those were for defensive purposes and resulted in about 120,000 U.S. dollars in excess charges and the unnecessary radiation per patient at about 8.8mSv.
Defensive medicine is based on physical uncertainty and litigation avoidance especially in high-risk areas such as the trauma ward where there is a higher probability of poor outcomes. Trauma surgeons react to this pressure by ordering CT scans reflexively which over time causes a financial burden on the healthcare system in addition to exposing patients to unnecessary radiation. Given the differences in CT scan costs and the charge-to-reimbursement ratio, defensively ordered CT scans contribute notably to the rising healthcare costs. The study also found that good clinical judgement was a guiding factor in ordering additional imaging scans to identify vital injuries particularly in the chest, brain, pelvis and abdomen. This study is crucial since it identifies specific behaviors of physicians in a distinct setting. The findings suggest that there should be a reform in the ordering CT scans process in order to prevent waste and avoid patient harm from unnecessary radiation.
From this study we can surmise that is necessary to alter the current practice environment for healthcare workers to one that is open about blunders and that has less misdiagnosis penalties allowing for learning through mistakes. Healthcare organizations should commit to establishing and maintaining a culture of safety based on open communication and medical error reviews using evidence-based methods. Additionally, personal accountability needs to be prioritized as opposed to the systems-based method which will in turn lower healthcare costs. Medical institutions should also be tasked with promoting educational programs about defensive medicine and its dangers. Healthcare administrators on the other hand can encourage behavior promoting reduced medical litigation through honesty and dispute resolution via arbitration and mediation. Full disclosure should also be granted to the patient and should be awarded fair compensation in the case of accidents or adverse events. Patients trust physicians they have a good rapport with and tend not to consider litigation against them. Nevertheless, physicians should not use this as an excuse to be careless when it comes to following evidence-based methods (Vento et al., 2018).

References

Chen, J., Majercik, S., Bledsoe, J., Connor, K., Morris, B., & Gardner, S. et al. (2015). The prevalence and impact of defensive medicine in the radiographic workup of the trauma patient: a pilot study. The American Journal Of Surgery, 210(3), 462-467. https://doi.org/10.1016/j.amjsurg.2015.03.016

Vento, S., Cainelli, F., & Vallone, A. (2018). Defensive medicine: It is time to finally slow down an epidemic. World Journal Of Clinical Cases, 6(11), 406-409. https://doi.org/10.12998/wjcc.v6.i11.406