Doctors' Dilemma: Lower Costs, Please Patients, or Avoid Lawsuits?

Leigh Page, MS


September 11, 2014

In This Article

Malpractice Threats Still Loom

Physicians who want to reduce costs and low-value services have to worry about malpractice laws, which have not changed one iota to accommodate the new cost-saving strategies.

Dr. Sullivan said the current system favors physicians who order more tests to make double-sure they have the right diagnosis. "The greatest single reason by far for malpractice filings is failure to diagnose," he said.

"When physicians follow Choosing Wisely guidelines and don't order as many tests, it's inevitable that they're going to miss a diagnosis from time to time," Dr. Sullivan said. Tests targeted by Choosing Wisely, in fact, may sometimes reveal diagnoses that had not been identified previously, but clinical experts have decided that the rate is too low to merit the time and expense, the possibility of false positives, and, in some cases, harmful effects such as radiation. But these tests still matter to plaintiffs' attorneys, he said.

Those who think these tactics are unfair are calling for state tort reform that would immunize physicians against lawsuits if they follow evidence-based guidelines. "Well-intentioned physicians should not be penalized for doing the right thing," said Matthew Mintz, MD, an internist at George Washington Medical Faculty Associates in Washington, DC. In a 2010 survey, 90.7% of physicians agreed that "unnecessary use of diagnostic tests will not decrease without protections for physicians against unwarranted malpractice suits."[8]

But don't hold your breath. Joel Shalowitz, MD, a clinical professor of health industry management at Kellogg School of Management in Evanston, Illinois, said he supports such reforms but they have no chance of passing in any state. "It will never happen because the plaintiffs' attorneys are too powerful," he said.

Conflicting Pressures Won't Go Away

Whether they like it or not, physicians are entering a more uncertain time. On the one hand, they are expected to develop new ways to control costs, but when they do so, the strategies will run up against a wide range of opposing forces that are not going away, such as patient preferences and the threat of malpractice suits.

Dr. Tilburt is sympathetic to this predicament, but he believes that the march to cost-saving measures will continue nevertheless."Increasingly, the profession is under pressure to get rid of waste," he said. "It's unavoidable that physicians will be asked, 'How much bang you are getting for your buck?'"


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