New healthcare reforms have been brought about by the increase in healthcare costs due to the current economic environment. One of these reforms that is an issue of debate involves defensive medicine and its effect on the healthcare system. Defensive medicine is the practice of running medical tests, consultations or procedures of uncertain clinical worth so as to avoid malpractice suits against a physician (Schneider, 2019). It is critical that healthcare professionals and policymakers have a detailed understanding on the culture of defensive medicine and how it contributes to the current U.S. healthcare expenditure that is expected to continue rising.
Tort law is the basis of the U.S. malpractice system. This means that it is the legal duty of physicians to not intentionally harm their patients or cause harm through negligence. Medical malpractice is important when compensating patients harmed through negligence, promoting justice for harmed patients and providing incentives for healthcare organizations to offer efficient and safe quality care. One study found that the malpractice costs may encourage defensive medicine behavior which in turn raise healthcare costs (Baungaard et al., 2020). Defensive medicine is thus linked to the liability crisis in the medical space. One approach to achieve low healthcare cost is to focus on patient-based care instead of tort reasons.
As healthcare providers order additional precautionary tests to prevent themselves from being sued while restricting high-risk procedures that may improve the quality of life for the patient, more patients may develop critical issues due or undergo chronic conditions owing to inadequate access to healthcare services. Defensive medicine can also result in negative effects such as physicians participating in avoidance practices including avoiding difficult procedures, sicker patients, patients with previous complications or those who had filed a lawsuit before. Another impact of defensive medicine is the fading of the mutual doctor-patient trust as physicians look at patients as potential plaintiffs or adversaries. Physicians may distance themselves from patients who seem unpredictable, emotional, noncompliant or demanding. This behavior is detrimental to healthcare quality and leads to decreasing job satisfaction. If there is no trust between the doctor and the patient, the patient is less likely to follow medical advice which leads to poor outcomes. On the other hand, physicians who are unhappy cannot return the trust of their patients and thus can’t provide quality healthcare. Low physician job satisfaction levels compromise doctor-patient ties and affects quality of care.
The ordering of unnecessary invasive procedures and tests in addition to being costly can also limit access to healthcare and be unsafe. During an invasive radiological procedure for example, an injected dye can cause a life-threatening allergic reaction can occur. Rather severe medical issues may arise during sensitive procedures like caesarian section. Caesarian section has increased as a form of defensive medicine and this has been linked to litigation exposure when birth complications occur. Redundant surgical procedures resulting in critical complications signify the impact of defensive medicine in patient care quality. There is a case that over investigating patients may be a practice that protects physicians but most evidence points to an increasing healthcare cost and potential harm to patients. Furthermore, health insurance companies usually raise their co-payments or premiums in accordance to extra healthcare expenses for their members which in turn increases healthcare costs in general. Defensive medicine advocates argue that it helps physicians avoid lawsuits, avert criticism, bypass complaints and preserve their reputation. Additionally, it may be beneficial to patients who discover medical issues previously unknown. Opponents of defensive medicine however argue that this practice gas professional and ethical consequences in medicine such as refusal to care for seriously ill patients, setting poor examples for future physicians, unnecessary and excessive healthcare costs, exposure of physicians to lawsuits and providing unnecessary prescriptions or examinations.
It is necessary to change the current environment healthcare workers practice in. A system that is more open about mistakes, with less penalties for misdiagnosis and that allows learning from these mistakes is needed. Additionally, individual accountability needs to be emphasized. Personal accountability as opposed to the current systems-based approach, may result in reduced defensive medicine and medical errors, which in turn lower the cost of healthcare. Researchers believe that educational programs must be bolstered to help discourage defensive medicine. Medical institutions are required to educate future physicians on defensive medicine and the dangers and cost linked to practicing it. Defensive medicine dangers with focus on care standards can be implemented in the curriculum in medical schools. Healthcare administrators should emphasize behaviors aimed at reducing medical litigation by practicing honesty and resolving disputes through arbitration and mediation. The patient should have full disclosure from the hospital administrators and physicians in the case of adverse events and should also be afforded a timely and fair compensation. Healthcare institutions should also cultivate a safety culture that bolsters open communication and review of medical errors using evidence-based practices. Patients tend to trust Doctors with whim they have a good rapport with and tend not to sue them in case of medical errors. However, this should not excuse the Doctors to be lax when it comes to adhering to evidence-based practices (Vento et al., 2018).

References

Baungaard, N., Skovvang, P., Assing Hvidt, E., Gerbild, H., Kirstine Andersen, M., & Lykkegaard, J. (2020). How defensive medicine is defined and understood in European medical literature: protocol for a systematic review. BMJ Open, 10(2), e034300. https://doi.org/10.1136/bmjopen-2019-034300

Schneider, A. (2019). Defensive medicine practice and effect on healthcare expenditures and tort reform. Nursing & Care Open Access Journal, 6(1), 42-44. https://doi.org/10.15406/ncoaj.2019.06.00181

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