Peer Pressure And Malpractice Fears Fuel Extra Tests

Fear about being sued for malpractice is, as you might expect, one of the main reasons doctors would order heart testing for patients, even if they aren't so sure the tests are absolutely necessary.

Doctor with stethoscope. i i

hide captionTime for a test?
Doctor with stethoscope.

Time for a test?

But peer pressure is also important, according to research just published in the the journal Circulation. Twenty-four percent of nearly 600 heart doctors surveyed said they'd ordered a cardiac catheterization — an imaging test to detect heart artery blockages — as a hedge against malpractice. But 27 percent said they would order one if they thought a colleague would do so in the same situation.

The answers emerged when researchers asked a national sample of cardiologists in the U.S. when they would order a cardiac catheterization "for other than purely clinical reasons."

Epidemiologist Lee Lucas of the Center for Outcomes Research and Evaluation in Maine, and lead author of the article told Shots:

We asked about five things: would you give the cath, one, because of malpractice worries; two, if the patient expected it; three, if the referring physician expected it; four, if your peers would order the test in a similar situation; and five, for monetary reasons, which no one reported, obviously.

In the survey, doctors were presented with three vignettes describing a heart patient and then asked what actions they'd take. If doctors replied they would order more exams, they'd be labeled a "more intensive practitioner". And, according to Lee, the likelihood a given doctor would order a catheterization out of worries about malpractice was related to how often the procedure was done in the area and the "intensivity" of the doctor.

Lucas said that the results of this study provide evidence that malpractice fears drive costs higher. "Malpractice reform may be able to have some impact on this variability of health care delivery, which often leads to increased health care spending," she said.

Since there are signs of regional variation, the next step, she said, is to break down data like these by state. She wants to look at whether doctors in the states where malpractice suits are more common are more fearful than doctors who practice in other places. "I don't think [these results] necessarily mean that lawsuits have run amok, but I think it means that docs are really worried about it....And it is changing their behavior," she said. "We want to see if the fear relates to the [state-by-state] reality in some way."



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