Stephanie Mencimer

The Myth of Defensive Medicine

Cross-posted from The Tortellini

Throughout all the big medical malpractice debates in recent years, doctors' groups and their political supporters have regularly insisted that fear of lawsuits forces physicians to practice expensive "defensive medicine." The idea is that to avoid suits, doctors prescribe unnecessary tests and treatments, thus driving up the cost of health care.

This argument always seemed to me pretty ridiculous, since performing unnecessary procedures on people is itself a form of malpractice. But also, in an era of managed care and increasingly stingy health care insurance coverage, average Americans never seem to be suffering from an excess of health care, at least not in their family doctor's offices.

A story this weekend in the Austin-American Statesman confirms my suspicions. The story is about a case headed to the Texas Supreme Court over an interesting technical issue, but the details show why the "defensive medicine" argument is such an empty one.

The plaintiff, Sharon Boyd, 57, made four different visits over 16 months to three different doctors, complaining of rectal bleeding and constipation. Not one of them ordered a single diagnostic test, not even a colonoscopy, which is recommended for everyone over 50, bleeding or not. Finally, 3 years after her initial complaints, Boyd demanded a colonoscopy. Turns out she had stage 4 colon cancer. She died not long after finding a lawyer. Cases like these are just far too common for defensive medicine to be anything but a myth...

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Posted at 7:03 PM, Jan 04, 2007 in
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What two or more doctors do is the standard of care, by definition. This case is frivolous per se, knowing no fact other than that more than one doctor is sued.

If the lawyer wants to change the standard of care at the point of a gun, that is irresponsible without adequate proof of benefit.

This lawyer wants everyone with rectal bleeding to have a colonoscopy, from hemorrhoids, anal fissure, constipation and straining. OK.

We will spend $billions on colonoscopies for millions of people. Frail, elderly people will receive anesthesia. Colonoscopy will pierce the bowel of a predictable fraction, requiring surgical treatment and management of blood infection. How many cases of cancer will be found? How many patients will have additional time of quality survival? At what cost in money and risk to the larger fraction without cancer?

Real world data point to an excess of referral for colonoscopies by family doctors, over and above the colonoscopy expert view.

Posted by: Supremacy Claus | January 5, 2007 9:12 AM