DEFENSIVE MEDICINE: REAL OR JUST ANOTHER BOOGEYMAN?

The cost of defensive medicine is one of the justifications being used for adding “tort reform” measures to whatever health insurance reform bill makes it out of Congress.
Tort reformologists blame greedy plaintiff’s lawyer and their injured patient clients for the high cost of health care. Objective studies demonstrating that defensive medicine adds to the problem of high health care costs are never cited by these tort reform advocates because no such study exists. Instead, they rely on anecdotal stories such as the following which recently appeared in an article advocating tort reform.
“All one has to do is walk the halls of hospitals or eat in the doctors' dining rooms in order to hear the ongoing frustration of physicians as they discuss ordering of unnecessary and excessive tests to protect themselves from the legal profession.”
Is it just me or is it hard to picture a group of doctors having lunch in the hospital cafeteria discussing their frustrations over all the unnecessary tests they had just felt compelled to order that morning? Doesn’t the picture seem more believable if they are, instead, discussing their frustrations over the stock market or their golf games?
Do doctors really routinely order tests they know are not necessary? Keep in mind that running up a patient’s bill for no good reason would violate: (a) medical ethics; (b) the fiduciary duty physicians owe their patients; and (c) federal law and regulations governing Medicaid and Medicare.
It may be that too many expensive tests are being ordered. If that is the case, the reason is more likely profit, not fear of some law suit being filed in the future. Acquiring diagnostic equipment represents a huge capital investment for a hospital. The hospital wants the expensive equipment to at least pay for itself, if not become a profit center. The only way the new state of the art MRI in the radiology department can become a cash cow for the hospital is if the hospital’s physicians used it extensively.
There is also a human factor that helps explain hospital physicians’ over-use of expensive diagnostic equipment. Emergency Room doctors are over-extended because hospitals under-staff their ER to save money. Screening a patient to determine if he or she should have an MRI or a CT Scan, for example, would typically entail a careful physical exam and a detailed medical history, both of which require time. With 10 other patients in curtained off ER rooms waiting to be seen, the temptation to skip the screening and just order the MRI or CT Scan “because we’re probably going to need it anyway” must be very powerful.
Defensive medicine. Boogeyman or real? In the absence of hard data, does it really seem likely defensive medicine is a factor in the overall cost of health care in our country? At the very least, should we not demand convincing proof that it is the culprit before agreeing to include “tort reform” restrictions on the rights of injured patients in the health care reform legislation that our country truly needs?