Malpractice suits have changed standards of care, JAMA study finds

Doctors order about one-third of tests, procedures in 'defense' of malpractice suits

Nearly one-third of the tests and procedures performed on patients are ordered by the physician to protect him or her from legal liability in some way, according to a study in JAMA Internal Medicine.

HHS: Hospitals must report out-of-court malpractice settlements

Details of the study

For the study, Cleveland Clinic researchers surveyed 36 physicians at three Baystate Health System hospitals. The physician evaluated 4,215 orders for 769 hospital inpatients. The doctors concluded that about 28% of the orders were at least partly "defensive," meaning it was done intent of protecting against possible litigation.

In addition, the doctors attributed about 13% of the costs to partly defensive orders, and about 2.9% of the costs to entirely defensive orders, meaning the orders were made only because of the fear of a malpractice lawsuit, researchers say.

"Some people might say it's defensive, and other people might think it's the standard of care," says lead author Michael Rothberg, adding, "There's really more of a culture about how people treat a particular problem, and many may not recognize it as being defensive."

Inside malpractice lawsuits: Why so many doctors don't see them coming

The researchers write in their study that clinicians should be protected when they follow evidence-based guidelines and tort reform, so clear communication about those guidelines could help assuage their fears and improve patient care.

Can the trend be reversed?

Some have argued that the Affordable Care Act missed an opportunity to tackle tort reform which could improve the efficiency of the health care system, Modern Healthcare's Sabriya Rice writes.

Zeke Emanuel: Why the ACA didn't include malpractice reform

Attendees of the American College of Surgeons' annual meeting this spring called on lawmakers to support initiatives to curb frivolous lawsuits. They say the Saving Lives Saving Costs Act would provide legal coverage to providers who adhere to clinician-developed best practices and appropriate-use guidelines (Rice, Modern Healthcare, 9/15 [subscription required]).

Does your organization need more legal protection?


Many physicians worry that more personal performance data means increased malpractice risk. In fact, concern over this issue has led some organizations to begin taking advantage of special data protections extended to Patient Safety Organizations.

But this is a questionable strategy.


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