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
Take a post-test and get CME credits
Please log in to ObGFirst to access the 2T US Atlas
OBG Project CME requires a modern web browser (Internet Explorer 10+, Mozilla Firefox, Apple Safari, Google Chrome, Microsoft Edge). Certain educational activities may require additional software to view multimedia, presentation, or printable versions of their content. These activities will be marked as such and will provide links to the required software. That software may be: Adobe Flash, Apple QuickTime, Adobe Acrobat, Microsoft PowerPoint, Windows Media Player, or Real Networks Real One Player.
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
Participants have an implied responsibility to use the newly acquired information to enhance patient outcomes and their own professional development. The information
presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
Jointly provided by
