In a much–hyped study, these authors attempt to address the important mythology of “defensive medicine”. As the self-preservationists have taught us, there’s nothing to be gained from judicious use of resources – particularly in any sense that outweighs the patient satisfaction and perceived diagnostic certainty resulting from overtesting.
But … is it true? Does healthcare spending at an individual level really equate to fewer lawsuits?
Maybe.
These authors looked just at the state of Florida, and looked specifically at the costs accumulated for the hospital discharges. Then, they correlated this data with closed malpractice claims, and broke it all down by clinician specialty. Impressively, the lowest quintile of spending was less than half the highest quintile. Then, when comparing clinicians with the lowest levels of hospital spending to those with the highest, the malpractice claim rate steadily decreased for each specialty involved.
Unfortunately, all this depends on the black box of statistical adjustment:
“We accounted for differences in patient characteristics and admission diagnoses between physicians by estimating a patient level multivariable linear model of total hospital charges during the hospital stay as a function of patient age, sex, race, diagnosis related group, indicator variables for Charlson-Deyo comorbid conditions, and year and physician indicators.”
One bit I do think quite strong in this paper is the dramatic association between caesarean delivery rates and diminished malpractice risk. However – is it all “defensive”? Or is there just a level of appropriate vigilance that avoids poor outcomes? Regardless, the trend is quite pronounced.
There is some bit of a leap to associated increased expenditures with defensive medicine, particularly given the various statistical adjustments for disease severity and patient characteristics. Whether defensive or not, however, the interaction between spending and litigation is quite consistent. I do think these data indicate what they are supposed to show, but it’s not as airtight as the hype.
“Physician spending and subsequent risk of malpractice claims: observational study”
http://www.bmj.com/content/351/bmj.h5516-0