The Cost of Defensive Medicine on 3 Hospital Medicine Services

Rothberg, Michael B.; Class, Joshua; Bishop, Tara F.; Friderici, Jennifer; Kleppel, Reva; Lindenauer, Peter K.

doi:10.1001/jamainternmed.2014.4649

Cited by 69 publications

(62 citation statements)

References 1 publication

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“…Our results are consistent with other studies that assessed the cost of DM on the healthcare system budget, both on the aggregate and patient levels [5,10,13,19,20]. This means that the practice of DM could represent one of the major causes of the budget deficit of the Italian National Health Service over recent years.…”

Section: Discussionsupporting

confidence: 91%

“…This result is consistent with the results of similar studies in other countries and with literature that suggests how medical malpractice reforms would reduce the costs of DM and litigation [5,7,13,24,30,31]. Recent papers argued that physicians" attitudes about DM do not correlate with legal risk and criticised the possible effect of tort reform [20,25]. We believe that tort reform is necessary, even though unlikely sufficient to eliminate the practice of DM, since half of the interviewed physicians did not mention it as the best system strategy [32].…”

Section: Discussionsupporting

confidence: 90%

“…Moreover, it is impossible to measure the portion of unconsciously practised DM, because it originates from requests by other specialists or because it is incorrectly ordered due to ignorance of best-practices evidence [10]. The cost of DM is also difficult to estimate due to the different methods that have been used in the literature [13,18,20,33]. We believe this measurement issue is the major limitation of our study and indeed all studies investigating DM.…”

Section: Study Limitationsmentioning

confidence: 95%

“…In the United States, DM is estimated to cost US $50-100 billion annually [18,19]. At the patient level, the practice of DM was also estimated to cost hospitals US$ 226, which is the 13% of the mean patient cost (US $1,695) [20].…”

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Defensive medicine in Italy a nationwide survey

Panella¹

2016

Fifth International Conference on Advances in Economics, Management and Social Study - EMS 2016

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Section: Discussionsupporting

confidence: 91%

Section: Discussionsupporting

confidence: 90%

Section: Study Limitationsmentioning

confidence: 95%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Defensive medicine in Italy a nationwide survey

Panella¹

2016

Fifth International Conference on Advances in Economics, Management and Social Study - EMS 2016

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“…The survey became part of the Cleveland Clinic study and showed that 28% of 4,200 orders were estimated as partially defensive, and 2.9% as completely defensive [17].…”

Section: Defensive Medicine In Various Countriesmentioning

confidence: 99%

Defensive Medicine: Myths and Realities

Tinică

Tomaziu-Todosia

et al. 2017

LUMEN Proceedings

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The phenomenon of defensive medicine existed for decades in the United States but in Romania emerged lately following malpractice litigation and mass media aggression. Defensive medicine develops when doctors prescribe tests or procedures and avoid to treat high-risk patients or to perform certain high-risk procedures in order to reduce the risk of medical liability. This essay discusses the basis and principles of defensive medicine, analyses its causes and effects and debates the major problems affectingRomanian healthcare system, notably cross-border medical assistance. Finally, the authors examine alternatives to prevent defensive medicine practices with emphasis on cardiovascular surgery. Among physicians, some degree of defensive medicine will always exist, as long as malpractice risks shadow the doctors' every footstep.

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Rationale for issuing neuroimaging requests for patients with primary headaches in China

Zhong,

Zhao,

Peng

et al. 2024

Brain and Behavior

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ObjectiveTo investigate the prevalence of neuroimaging in patients with primary headaches and the clinician‐based rationale for requesting neuroimaging in China.Data sources and study settingThis study included patients with primary headaches admitted to hospitals and clinicians in China. We identified whether neuroimaging was requested and the types of neuroimaging conducted.Study designThis was a cross‐sectional study, and convenience sampling was used to recruit patients with primary headaches. Clinicians were interviewed using a combination of personal in‐depth and topic‐selection group interviews to explore why doctors requested neuroimaging.Data collection:We searched for the diagnosis of primary headache in the outpatient and inpatient systems according to the International Classification of Diseases‐10 code of patients admitted to six hospitals in three provincial capitals by 2022.We selected three public and three private hospitals with neurology specialties that treated a corresponding number of patients.Principle findingsAmong the 2263 patients recruited for this study, 1942 (89.75%) underwent neuroimaging. Of the patients, 1157 (51.13%) underwent magnetic resonance imaging (MRI), 246 (10.87%) underwent both head computed tomography (CT) and MRI, and 628 (27.75%) underwent CT. Fifteen of the 16 interviewed clinicians did not issue a neuroimaging request for patients with primary headaches. Furthermore, we found that doctors issued a neuroimaging request for patients with primary headaches mostly, to exclude the risk of misdiagnosis, reduce uncertainty, avoid medical disputes, meet patients’ medical needs, and complete hospital assessment indicators.ConclusionsFor primary headaches, the probability of clinicians requesting neuroimaging was higher in China than in other countries. There is considerable room for improvement in determining appropriate strategies to reduce the use of low‐value care for doctors and patients.

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The Cost of Defensive Medicine on 3 Hospital Medicine Services

Abstract: participated in data collection and did not receive compensation for their roles.

Cited by 69 publications

References 1 publication

Defensive medicine in Italy a nationwide survey

Defensive medicine in Italy a nationwide survey

Defensive Medicine: Myths and Realities

Rationale for issuing neuroimaging requests for patients with primary headaches in China

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