Playing defense adds to health costs

Robert Farmer, M.D. Mar. 21, 2010, 2:34pm

Let us look at some simple math and very basic facts regarding the health care reform debate. Last year, 70 million CT scans, at an average cost of $1,000 each, were performed in the U.S. at a cost of $70 billion. Why would 70 million CT scans be done in a country of 300 million people? Quite simply -- defensive medicine.

As a family physician I practice defensive medicine every day. Every physician I know does the same thing. They freely admit to it. We all do so for self-preservation. If one were to be sued, intuitively it sounds better to a jury that, "Hey, I ordered all of the tests," than answering a plaintiff's attorney's accusation of, "Why on earth, Doctor, didn't you just order the test?"

One does not need an Ivy League study or an American Medical or American Bar Association lobby-subsidized analysis to reveal what the CT scan numbers demonstrate. To the contrary, one simply needs to apply simple math to simple numbers to understand that one of the driving costs to today's health care expenditures is ordering tests that are done solely to serve as a defense in court should the need arise.

No question many CT scans are legitimately needed and assist in diagnosis and treatment. No question many CT scans are driven by defensive medicine. It is not unusual for ER physicians to reflexively order a CT scan of the head for anyone who presents to the ER with a headache. In fact, at one Belleville hospital, an estimated 150 CT scans of the head are performed every month. That is of the head alone, every single month, in just one hospital.

The point of this column is not to argue the merits of lawsuits or the legitimacy of the practice of defensive medicine. The point, simply, is that no one looks at the real burden to the system of defensive medicine.

Sen. Dick Durbin, for instance, likes to state that medical malpractice costs such as jury payouts and malpractice premiums are such a small portion of the total economy of health care, they are not worth the time to address. Such an argument is nothing more than a shell game. Throw out every dime in premiums and jury payouts -- do not even consider them -- and one still has that pesky little $70 billion CT scan expenditure hanging out there.

Any honest assessment demonstrates that the defensive medicine implications relating to health care expenditures are real. $70 billion in one year for CT scans alone is only the tip of medical delivery costs. We have not even considered the costs of MRIs, joint replacements, heart disease, diabetes, cancer care, colonoscopies, etc.

If our elected officials truly have as their desire meaningful reform of our health care system, somewhere in 2,400 pages of legislation one would expect to see a sincere attempt to address defensive medicine costs. No such attempt exists. A true understanding of the problem would be revealed in wording that dealt with why $70 billion was spent in one year on CT scans.

Any politician who claims to want to reform health care and control costs but chooses not to address the drag defensive medicine places on the system is either the village idiot or the village liar.

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