If we completely abolished all medical malpractice lawsuits…
…it still wouldn’t stop doctors from ordering unnecessary tests. There’s at least two reasons why. First:
But defensive medicine - tests and procedures ordered to protect against medical-malpractice lawsuits - can also add to costs.
"As a resident, the first thing you learn is that your license is on the line," said Dr. Faisal Qazi, an Upland neurologist.
Newly graduated doctors learn that if they don't do an extra test and something goes wrong, it would at the very least result in a hassle and loss of productivity and income.
I’d like to see someone argue with a straight face that we need to stop disciplining doctors who make mistakes. Unless and until we did that, doctors would still be in fear that leaving some stones unturned might result in disciplinary action against them.
But Chandra, a professor of public policy at Harvard's John F. Kennedy School of Government who has researched defensive medicine, said he believes many of those purported expenses are actually because of the way insurance and government payments are structured.
"The way the system is set up, the more you test, the more imaging you have done, the more you get paid," he said. "But don't just blame the doctors. It's the perverse reimbursement system we have."
Although detractors of the legal system decry frivolous lawsuits, less than 10 percent of patients with a legitimate claim end up suing, Chandra said.
The classic example of “unnecessary tests” is that of the MRI. Some people argue that physicians routinely order MRI’s when there’s any hint of a head injury, regardless of whether an MRI is needed. First off, I’d like to note that these and other anecdotes should have absolutely no place in determining the shape of our legal system. Plaintiffs who have been injured by their doctors need more – much more – than anecdotal evidence to prove their doctor acted negligently. The quantum of evidence necessary for a patient to have his or her day in court should be no more than the quantum of evidence to eliminate his or her rights. (I know, I’m naive to assume that political decisions will ever be made with the same precision that judicial systems are made.)
But back to MRI’s. “When doctors become invested in an outpatient surgery center, they perform on average twice as many surgeries as doctors with no such financial stake…” And that’s for surgical procedures, not a noninvasive test like an MRI. The bottom line is that as long as it is profitable for doctors to order unnecessary procedures & tests, they will continue to order them. This isn’t even complicated enough to be worthy of calling it “Economics 101.”
You know what I’d really like to see? A doctor run his or her business like trial lawyers do. “No cure, no fee!” Maybe that’s not realistic, but unless and until we remove financial incentives for doctors to order unnecessary procedures, doctors will keep ordering them. And whatever changes we make to the tort system won’t make much difference.