"Defensive Medicine" a Sham Argument in Health Care Reform Debate

We’ve heard a lot about doctors practicing "defensive" medicine in an effort to avoid "frivolous" lawsuits. Of course, there is no evidence to suggest that so-called defensive medicine actually exists, or if it does, that it effects the cost of health care.

What we have learned, though, is that increased tests and studies can in fact increase a physician’s bottom line. The Washington Post reported today on the practice of "self-referrals." Self-referrals occur when a doctor orders a test that he or she conducts for the patient. Consider the case of a urology clinic in Illinois:

In August 2005, doctors at Urological Associates, a medical practice on the Iowa-Illinois border, ordered nine CT scans for patients covered by Wellmark Blue Cross and Blue Shield insurance. In September that year, they ordered eight. But then the numbers rose steeply. The urologists ordered 35 scans in October, 41 in November and 55 in December. Within seven months, they were ordering scans at a rate that had climbed more than 700 percent.

So, why the huge increase in CT scans? Was it "defensive" medicine to stave off lawsuits? Nope:

The increase came in the months after the urologists bought their own CT scanner, according to documents obtained by The Washington Post. Instead of referring patients to radiologists, the doctors started conducting their own imaging — and drawing insurance reimbursements for each of those patients.

So is this an isolated incident? Nope:

A host of studies and reports by academics and the federal government shows that physicians who own scanners order many more scans than those who do not. As a result, Americans pay billions of dollars in extra taxes and insurance premiums.

An attempt to pass this or some other practice off as "defensive medicine" is a scam. Even when a lawsuit is filed, a plaintiff needs an expert, generally in the same or similar field as the defendant, to testify as to the standard of care. It’s not as if attorneys can simply come up with tests that should be ordered; doctors set the standard of care in their professional fields.

So next time someone suggests that they ordered a test because they were afraid of a lawsuit, ask them how much they were compensated for that "unnecessary" test.