The practice patterns of physicians have a significant impact on the quality and cost of the health delivery system. The unlimited liability a physician faces for medical mistakes does influence a physician’s practice behavior. Defensive medicine occurs when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily solely) to reduce their exposure to malpractice liability.
When physicians do extra tests or procedures primarily to reduce malpractice liability, they are practicing positive defensive medicine (9 out of 10 “high risk” specialists). When they avoid certain patients or procedures, they are practicing negative defensive medicine. To build up an effective defense, a physician may resort to practicing medicine inappropriately (Studdert, 2004). In recent years, the number of medical negligence suits has burgeoned radically. In the 1990s, seven of every one hundred U. S. physicians could anticipate to be sued for malpractice annually.
As a result, there has been a marked increase in medical costs including malpractice insurance for physicians and the practice of defensive medicine by doctors who order more tests than required in order to protect themselves from malpractice suits. Similarly, malpractice awards to victims have markedly increased (Thompson, 1990, p. 155). Undoubtedly, from a public and societal viewpoint, medical practice should be judicially supervised, including the disposition of medical negligence litigation.
The main goals are to deter negligent practice and thereby to improve the quality of medical care, and to provide appropriate compensation for people harmed by medical negligence. On the other hand, the flooding of courts with malpractice cases and the defensive overuse of medical tests by physicians have negative effects on medical education, the proper use of medical technology, and the improvement of the quality of medical care. One recent study found that “0. 13% of all hospitalized patients in the United States file malpractice suits against physicians” (Steinberg, 2003, p. 626).
This number, however, stands for only a part of the several iatrogenic problems created by physicians against patients in hospitals. The majority patients never sue in court for medical malpractice. Variety of studies shows that eight to tenfold more acts of negligence are performed than the number of malpractice litigations. These figures have not changed over many years, in site of the increased absolute number of malpractice and negligence suits in the courts. In only one of fourteen suits is the claimant awarded compensation. It is not all clear that malpractice suits have improved the quality of medical care.
Moreover, physicians who are sued for medical negligence are not found to be deficient in their technical expertise and medical knowledge; rather they are sued because of their poor communication skills with patients. A high percentage of physicians are sued repeatedly. A previous lawsuit against a physician increases the probability of another one, as does the awarding of very high compensation to a previous victim. Contrariwise, the dismissal of a previous lawsuit or the lack of award of compensation to the victim makes a repeat lawsuit against a physician less likely.
Physicians now practice defensive medicine and are angry. Lawsuits harm their professional reputation, are often without merit, generate animosity between the medical and legal professions, and have minimal educational value for physicians. Not only have malpractice suits not clearly accomplished their goals of improving medical care and compensating victims where appropriate, but they have produced serious negative consequences such as the widespread practice of defensive medicine.
Physicians are concerned with the possibility of future litigation with negative impact on patients who now undergo many unnecessary tests and procedures which may produce physical and mental suffering. Patients are often sent to numerous specialists for consultation to deflect responsibility from the primary care physician, increasing their worries and efforts just to seek medical help. Some physicians also limit their practice or choose not to specialize in specialties such as obstetrics with high numbers of malpractice suits.
According to the American College of Obstetricians and Gynecologists (ACOG) 1992 survey, 22. 8 percent of its members surveyed decreased their high-risk obstetric care, 12. 3 percent stopped practicing obstetrics, 10. 1 percent decreased the number of deliveries, 8 percent reduced gynecological surgical procedures, and 2. 4 percent no longer do major gynecological surgery. Another negative outcome of the malpractice crisis in the United States, due in part to the excessive compensation awards, us the high cost of medical malpractice insurance, which adds to the overall health budget with minimal benefit return.
Legal remedies are being sought in the United States to deal with the malpractice crisis. Studies in the United States found that the poor, the uninsured and the elderly sue less often for medical negligence. Sex and race do not influence the frequency of malpractice suits. It is estimated by malpractice attorneys that fewer than 10 percent of the malpractice lawsuits that are filed actually go to court. It is also estimated that of those that go to court, only 10 percent follow through a final judgment.
The remainder of cases are settled out of court either by plea bargaining, agreement, arbitration, or mediation. Settling out of court may take place anytime prior to judgment (American College of Obstetricians and Gynecologists, 1994). It can be concluded that due to the high liability of physicians, they tend to resort to defensive medical practices. In addition to this, the burgeoning number of physicians practicing such method, results in an increase in the number or rate of malpractice or negligence.
As such, an action plan must be sought to reduce the potential for malpractice litigation. In this aspect, risk management can be considered or utilized. Its goals are to educate physicians to communicate better with patients and their families, to ensure high-quality medicine following accepted standards and to address medical mishaps and failures rapidly before they result in negative consequences (such as additional costs, poor service and medical care).
In addition to this, it also aims to inform the medical community about malpractice litigation and its consequences and to develop and implement specific clinical practice guidelines for the diagnosis and treatment of common illnesses. Though, it remains to be seen whether these steps will reduce malpractice suits, still, the possibilities for reduction in malpractice suits, resulting in the decrease of liability fears among physicians, and consequently, reduce in defensive medicine, malpractice and negligence cannot be ignored. As they usually say “prevention is better than cure. ”