Defensive Medicine, Cost Containment, and Reform

Hermer, Laura D.; Brody, Howard

doi:10.1007/s11606-010-1259-3

Cited by 134 publications

(128 citation statements)

References 25 publications

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“…This might occur when some physicians initially order extra tests due to fear of malpractice, but over time their behaviors became assimilated into the communities' standard of care, so that eventually groups of physicians start ordering these tests primarily because they believe the tests are effective and medically indicated, and not due to fear of litigation. 49,52 While we did not measure physicians' perceptions regarding their medical communities' standard of care, we did measure physician belief in the clinical effectiveness of breast MRI for an average risk population, which was significantly associated with offering extra breast cancer screening tests. This is consistent with other published literature that found an association between primary care physician belief in the usefulness of MRI and increased utilization of MRI.…”

Section: Resultsmentioning

confidence: 99%

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

et al. 2013

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Section: Resultsmentioning

confidence: 99%

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

et al. 2013

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“…16,17,[45][46][47][48] While some have advocated that tort reform should be central to policies aimed at reducing excessive medical spending, 45,49 studies evaluating the effect of actual reform efforts have demonstrated a limited effect on cost reduction and physician behavior. 46,[49][50][51][52][53][54] However, given the high malpractice concern among physicians in our sample and others, 17,45,51 we believe that although tort reform would not be sufficient to eliminate overuse, 54 it may be a necessary initial step. As long as the specter of liability is so prevalent, it may be difficult to convince EPs to change their practice patterns.…”

Section: Discussionmentioning

confidence: 99%

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Kanzaria

Hoffman

Probst

et al. 2015

Academic Emergency Medicine

175

146

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Objectives: The objective was to determine emergency physician (EP) perceptions regarding 1) the extent to which they order medically unnecessary advanced diagnostic imaging, 2) factors that contribute to this behavior, and 3) proposed solutions for curbing this practice.Methods: As part of a larger study to engage physicians in the delivery of high-value health care, two multispecialty focus groups were conducted to explore the topic of decision-making around resource utilization, after which qualitative analysis was used to generate survey questions. The survey was extensively pilot-tested and refined for emergency medicine (EM) to focus on advanced diagnostic imaging (i.e., computed tomography [CT] or magnetic resonance imaging [MRI]). The survey was then administered to a national, purposive sample of EPs and EM trainees. Simple descriptive statistics to summarize physician responses are presented.Results: In this study, 478 EPs were approached, of whom 435 (91%) completed the survey; 68% of respondents were board-certified, and roughly half worked in academic emergency departments (EDs). Over 85% of respondents believe too many diagnostic tests are ordered in their own EDs, and 97% said at least some (mean = 22%) of the advanced imaging studies they personally order are medically unnecessary. The main perceived contributors were fear of missing a low-probability diagnosis and fear of litigation. Solutions most commonly felt to be "extremely" or "very" helpful for reducing unnecessary imaging included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%). Conclusions:Overordering of advanced imaging may be a systemic problem, as many EPs believe a substantial proportion of such studies, including some they personally order, are medically unnecessary. Respondents cited multiple complex factors with several potential high-yield solutions that must be addressed simultaneously to curb overimaging.ACADEMIC EMERGENCY MEDICINE 2015;22:390-398

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“…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]. Rather, a significant portion of the sample claimed that it would be better to promote a more positive public climate around physicians, with more emphasis on good practices and attention to physicians" rights.…”

Section: Discussionmentioning

confidence: 88%

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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Defensive Medicine, Cost Containment, and Reform

Cited by 134 publications

References 25 publications

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

Emergency Physician Perceptions of Medically Unnecessary Advanced Diagnostic Imaging

Defensive medicine in Italy a nationwide survey

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