Doctors Do More Defensive Medicine After Colleagues Get Sued

Wayne J. Guglielmo, MA


September 23, 2019

In This Article

Perceived malpractice risk may be a bigger driver of defensive medicine than actual risk, according to a JAMA Internal Medicine study published last month.

To confirm prior research on the topic—and to explore what, if any, factors affected the perception of risk—Dan Ly, an internal medicine specialist and health policy researcher at Harvard, looked at a cross-section of Florida doctors whose colleagues had had an injury report filed against them.

Specifically, he wanted to know whether such a report, typically a precursor to a medical malpractice claim, had influenced doctors to order more diagnostic imaging for their Medicare patients after an evaluation and management (E/M) visit.

Using Medicare claims data and injury reports filed with the Florida Office of Insurance Regulation, Ly chose 361 physicians whose peers had at least one injury report filed against them and examined patients' medical records for a period ranging from four quarters before to four quarters after the report. He identified the quarter immediately before the report being filed as his reference point—which is to say, as a baseline for judging whether any increase or decrease in the average rate of diagnostic testing had in fact occurred.

For the reference period, the average rate of advanced testing, including PET and MRI, was 2.3 per 100 E/M visits. In the quarter after a peer had an injury report filed against him or her, that rate rose by 0.78 per 100 E/M visits—an almost 34% jump. The uptick didn't last, however: For the second quarter after the report, the difference from the reference period was no longer statistically significant.

Reports of injuries resulting in death, the author found, led to a larger increase in imaging than those that did not.

Ly says that his findings are consistent with prior research "which suggests that perceived malpractice risk, rather than objective malpractice risk, may influence defensive medicine."

He also acknowledges the limitations of his study. One is that it doesn't—indeed couldn't—"distinguish responses based solely on malpractice concerns from responses based on [doctors] wanting to avoid similar injuries [caused by their peers]."

A second limitation is that the findings are restricted to incidents involving Florida Medicare patients, which may reduce the generalizability of the results to other populations.


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