February 18, 2011 / 7:52 PM / 9 years ago

'Defensive medicine' common in orthopedics

NEW YORK (Reuters Health) - A new survey of orthopedic surgeons in Pennsylvania shows roughly a third of the imaging tests they order are meant to protect them from lawsuits instead of helping their patients.

“That represents an enormous amount of money that we’re wasting that could be spent on other health care needs,” Dr. John M. Flynn, from Children’s Hospital of Philadelphia, told Reuters Health.

He presented his findings at the annual meeting of the American Academy of Orthopedic Surgeons in San Diego this week.

Earlier surveys have found rates of defensive medicine — where physicians order diagnostic tests of little benefit to the patient largely to protect themselves from a lawsuit — to be as high as 93 percent. But those surveys simply asked whether or not the doctor practiced defensive medicine.

“Just saying that you do defensive medicine gives us no sense of what that means. Our study is the first to prospectively capture and analyze what tests physicians were ordering, and for what reason, in real time,” Flynn said.

He and his colleagues asked members of the Pennsylvania Orthopedic Society to voluntarily and anonymously record a series of imaging orders they made on one day in their clinic, emergency department, or hospital.

“We asked for one day in the life of (the) practice, and to check a box for each imaging test they ordered — x ray, MRI, CT scan, and so on,” Flynn explained.

Recently, many physicians have sounded the alarm about what they see as excessive rates of CT scans, which would expose patients to unnecessary radiation and cancer risk.

The researchers also asked the surgeons whether they ordered the tests for defensive purposes, or believed they would actually benefit the patient.

The 72 orthopedic surgeons in the study had just more than 2,000 patient encounters and ordered imaging studies for defensive purposes in almost one in every five encounters.

Overall, defensive medicine accounted for nearly a third of the images they ordered. In financial terms, that came to $113,369 of the $325,309 in total imaging charges, based on Medicare dollars.

“And that’s one specialty in one state on one day,” Dr. Flynn said. “You can imagine what that extrapolates out to, in an environment where we are trying to deal with rising health care costs. This is something that policy makers need to be aware is happening every day.”

The study also showed that being sued in the last 5 years and being in practice longer than 15 years made doctors more likely to order imaging tests for defensive purposes.

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