Defensive Medicine Claims: A Pig is Still Just a Pig

This whole “defensive medicine” bandwagon that physicians and their associations have pounced on continues to be a bit of a mystery to me.

The argument goes that because physicians are so very afraid of being sued, they order tests that are actually unnecessary. First, I have to wonder if the “unnecessary test” ordered for a patient that actually discovers a significant finding is included in their tally, but I know if I were that patient I would be in favor of the medical communities’ “unnecessary testing”.

In addition, their entire argument ignores the lack of any objective study or statistics supporting their claims that “defensive medicine” practice is necessary to begin with; but that is another article for another day.

MedPage Today reported that the following types of tests are ordered by orthopedic physicians and the percentages represent the alleged “defensive medicine” label:

• Plain x-rays: 19%
• CT scans: 26%
• MRI scans: 31%
• Ultrasound studies: 44%
• Blood and other lab tests: 23%
• Biopsies and aspirations: 18%
• Subspecialty referrals and consultations: 35%
• Hospital admissions: 7%

In the same publication, orthopedic physicians claim they have ordered a total, nationwide, of $2.1 billion per year in “defensive medicine” tests.

Now, one of two things are true it seems to me:

1. The tests being ordered are based upon signs and symptoms that the physician believes, based on their experience and training, are needed in order to be sure a patient does not have one injury, disease or another; or
2. 20,400 orthopedic surgeons are committing $2.1 billion per year in fraud.

Let’s take a common place example. If a plumber was worried about being sued and performed $5000 in unnecessary repairs, what would we call that? I think “fraud” or theft are probably the words most people would use for the plumber’s actions.

Physicians, however, boldly admit to fraud, but claim they have a good reason for committing that fraud(?)

A spokesman for the American Academy of Orthopedic Surgeons was quoted:

Asked about the disconnect between the judicial system’s and physicians’ interpretations of medical necessity, Jahangir told MedPage Today that evidence-based clinical practice guidelines would go a long way toward eliminating it.

Such guidelines, he said, would better define what constitutes necessary versus unnecessary procedures — “what really needs to happen [to achieve] the patient’s best outcome.”

Let me interpret for you: Dr. Jahangir’s group wants “evidence based clinical practice guidelines” changed in order to give physicians “cover when they fail to order a test that reasonably should have been ordered in the best interest of the patient. Not in the best interest of insurance companies or physicians, but in the best interest of the patient.

I have said this a number of times before. These tests that doctors want to claim are ordered as a result of their supposed need to practice defensive medicine are either medically necessary or fraud. You simply do not get to call a pig anything other than a pig!