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Doctors’ Fear of Malpractice Causes a Lot of Unnecessary Care

Physicians say that overtreatment of patients is common, citing fear of malpractice as the top concern behind this trend.

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Many physicians in the United States believe that patient overtreatment is common.

And it’s a trend driven largely by doctors’ fear of lawsuits, according to a new study.

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Researchers surveyed 2,106 physicians online regarding their attitudes about unnecessary medical care.

They also asked them to name possible causes and solutions for this problem.

Both primary care doctors and specialists participated in the study, which was published September 6 in the journal PLOS ONE.

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On average, physicians who responded believed that 20 percent of all medical care in the United States is unnecessary.

This includes almost 25 percent of medical tests, 22 percent of prescription medications, and 11 percent of procedures.

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Only about 5 percent of doctors thought that all care provided was medically necessary.

The top reason physicians gave for overtreatment was fear of malpractice — cited by around 85 percent of doctors.

Patient demands for medical care closely followed and, further down the list, difficulty accessing patients’ medical records from other clinics or hospitals.

In addition, around 71 percent of those who responded thought that doctors are more likely to perform unneeded procedures if they profit from them. However, only 9 percent said that their own financial security was a factor.

“Interestingly, but not surprisingly, physicians implicated their colleagues — more so than themselves — in providing wasteful care. This highlights the need to objectively measure and report wasteful practices on a provider or practice level so that individual providers can see where they might improve,” study author Dr. Daniel Brotman, professor of medicine at the Johns Hopkins University School of Medicine, said in a press release.

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Doctors who responded said that training medical residents on criteria used to choose appropriate care could reduce overtreatment.

They also suggested that providing better access to patients’ outside medical records and having more practice guidelines could help as well.

Unnecessary care difficult to reduce

The Institute of Medicine reported that in 2009, “unnecessary services” accounted for an estimated $210 billion of the $750 billion wasted on inefficient healthcare spending in the United States each year.

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“Unnecessary medical care is a leading driver of the higher health insurance premiums affecting every American,” said study author Dr. Martin Makary, professor of surgery and health policy at the Johns Hopkins University School of Medicine, in the press release.

The amount of overtreatment varies with specialty.

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For example, some studies have found that 30 percent of inpatient antimicrobial therapy is unnecessary or inappropriate, as is 26 percent of advanced imaging tests.

Overtreatment isn’t just a question of money, though.

Overuse of antibiotics can increase the risk that bacteria become resistant to those lifesaving medications. Also, every medical procedure carries some risk of side effects or complications.

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Choosing Wisely, an initiative of the ABIM Foundation, provides information for physicians and patients about which medical tests, treatments, and procedures are most appropriate for certain conditions — and which may not be needed.

A recent study in Health Affairs found that this effort, launched in April 2012, may have contributed to a 4 percent decrease in unnecessary imaging tests over a two-and-a-half-year period.

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Finding solutions to overtreatment

Although doctors in the PLOS ONE study cited “fear of malpractice” as a top reason for overtreatment, this may not be well-founded.

Only 2 to 3 percent of patients harmed by medical negligence actually choose to sue. And of those, only about half receive compensation.

Since the early 2000s, the rate of lawsuit claims paid by physicians have dropped by about 50 percent — falling to about 10 paid claims for every 1,000 physicians in 2013.

Doctors also face demands from patients — especially with the rise of medical information online — who may sometimes think that “more care is better.”

A 2012 study in the Journal of Medical Ethics suggests that most patients prefer to leave medical decisions to doctors. However, the study also found that almost every patient surveyed wanted their doctor to “offer them choices and to consider their opinions.”

To provide patients with this careful balance of being heard and being guided, many doctors practice what’s known as “shared decision-making.” Some research suggests that this can lead to more conservative medical care.

Better sharing of medical data could also reduce the need for physicians to order tests that a patient had done at another medical office or hospital.

A 2014 study in the journal Medical Care found that better sharing of electronic health records in California and Florida reduced repeat imaging tests. Chest X-rays were reduced by 13 percent, ultrasounds by 9 percent, and CT scans by about 8 percent.

This was just from integrating two parts of the nation’s healthcare system. Connecting the electronic records of all hospitals, doctors’ offices, medical laboratories, pharmacies, and insurers could save $77 billion each year.

Many studies have focused on waste in the American healthcare system. But this survey gives doctors — the frontline providers — a chance to identify what they feel are the top reasons behind overtreatment.

“Most doctors do the right thing and always try to. However, today ‘too much medical care’ has become an endemic problem in some areas of medicine,” said Makary. “A new physician-led focus on appropriateness is a promising homegrown strategy to address the problem.”

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