Medical malpractice claims began to rise in the 1960s, likely driven by new and more complex treatments with higher risks of iatrogenic harm and changes in liability law. The increase in such claims led organized medical groups to request reforms to medical liability laws. These groups asserted that recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but rather an option that serves to protect the physician against claims of malpractice with the patient as potential plaintiff (also known as ‘defensive medicine’), was unnecessarily increasing costs of healthcare. Some states, in response, have adopted damage caps on noneconomic damages such as pain and suffering.
Researchers (JAMA Cardiology, 2018) studied the question of whether tort reform has changed physician behavior for specific conditions involving clinical uncertainty such as coronary artery disease (CAD), a leading cause of death in the US. The research found that physicians in states with caps on noneconomic damages performed testing at the same rate in states without caps. But the testing was less invasive (meaning fewer initial angiographies and less progression from initial stress test to angiography), and revascularization through PCI following initial testing declined. It appears that physicians in states with capped noneconomic damages are willing to tolerate greater clinical uncertainty in CAD testing and treatment if they face lower malpractice risk.
Furthermore, some authors (PloS One, 2018) looked at whether there is a connection between the increase in thyroid cancer incidence and the malpractice climate. They suggest that this increase is “a product of greater defensive medicine in states with higher malpractice risk, which leads to increased diagnostic testing of patients with thyroid nodules and potential overdiagnosis.”
Lessons from a decade of technical-scientific opinions in obstetrical litigation
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