The underlying culture of health care providers in the United States, not greed or a fear of facing a medical malpractice lawsuit, appears to be the driving force behind many expensive and unnecessary medical testing, often referred to as defensive medicine, according to the findings of new research.
In a study published earlier this month by the medical journal JAMA Internal Medicine, researchers working with Veterans Affairs hospitals indicate that doctors at the government-run medical centers, who are generally shielded from the effects of most malpractice lawsuits, request just as many unnecessary medical tests as their peers in the private sector, who are far more vulnerable to lawsuits.
Researchers looked at the rate doctors used myocardial perfusion imaging (MPI) to test patients for coronary ischemia. The tests are conducted millions of times each year, but many experts are concerned that they are often unnecessary, either because the doctor fears a potential lawsuit or because they are trying to profit from self-referral.
MPI, also known as myocardial perfusion stress testing, is a form of nuclear medicine that exposes the patient to radiation, increasing the risk of cancer. MPI also exposes the patient to potential allergic reactions from dyes.
The study looked at the use of MPI at one VA hospital. Doctors who work for the VA are much more insulated from lawsuits, as laws require complaints against the VA to go through a stringent approval process that emphasizes resolution through mediation.
Researchers expected to find a much lower use of MPI at the VA hospital when compared to private and public hospitals. Instead, they found the rates were about the same, and VA doctors were just as likely to prescribe unnecessary MPI tests as other doctors.
According to the findings, about 13% of the tests are unnecessary based on guidelines for MPI tests outlined by the American College of Cardiology Foundation and the American Heart Association. Not only is there a risk from the tests themselves, but false positives could result in patients undergoing unnecessary medical procedures, such as heart stents.
The lead researcher, Dr. David Winchester, from Malcolm Randall VA Medical Center in Gainesville, Alabama, concluded that neither potential profit from self-referrals nor fear of medical malpractice lawsuits was driving the unnecessary tests. Dr. Deborah Grady, an editor with JAMA Internal Medicine, wrote that the overtesting appears to be a product of the culture of the medical community.
Overtesting adds considerable costs to healthcare, experts say. Much of it has been blamed on defensive medicine due to fear of medical malpractice lawsuits, which has contributed to the push for tort reform in recent years. However, studies have indicated that medical malpractice is not actually driving up the cost of medicine to any significant degree.
A recent study by Johns Hopkins researchers found that payouts in substantial medical malpractice claims add less than 1% to the cost of health care in the United States.