Critical Condition

Defensive Medicine Not Only Costs, It Kills

New research widely publicized this week points to the dangers of defensive medicine — the ordering of unnecessary tests, procedures, and consults not out of medical necessity but as legal protection from the trial bar.

Computed tomography (CT) scanning is one of modern medicine’s most helpful tools. CT scans can assist doctors in diagnosing disease by providing a lucid view of internal organs. They are quicker than an MRI and give much more detail than a plain film X-ray.

Unfortunately, CT scans have become one of the most egregiously overused tools in medicine. As one of the new studies from the Archives of Internal Medicine notes, approximately 70 million CT scans are now ordered every year — a greater than threefold increase since 1993.

While not every patient who enters the emergency room receives a CT scan, a great many do — CT scans have almost become a rite of passage for ER visits. In many situations, doctors could make the correct medical decision based solely on clinical judgment without the assistance of imaging. In today’s litigious society, however, with advertisements for malpractice lawyers sometimes as close as the ER doors, doctors feel compelled to order every test possible.

But all other medical interventions, CT scans have side effects: They expose patients to significantly more radiation than standard X-rays. The authors of the new study linked above attempted to assess the health risks associated with CT scans. They concluded that the CT scans conducted in 2007 alone will result in an estimated 29,000 future cases of cancer, including an estimated 6,200 cases of lung cancer, 3,500 cases of colon cancer, and 2,800 cases of leukemia. The authors project that the CT scans ordered in 2007 will cause 14,500 cancer deaths. These numbers will only continue to rise if CT scans continue to become ever more widely prescribed.

To be clear, the researchers strictly attribute the incidences of cancer and the deaths to CT scans per se and not defensive medicine. However, a sizable fraction of those scans were ordered for just that purpose.

Tort reform could help reduce this trend. If it were included in broader health care reform efforts, malpractice reform could save lives. Unfortunately, tort reform is nowhere to be found among the thousands of pages of the Democrats’ so-called reform legislation.

– Jason D. Fodeman, M.D., is an internal medicine resident at UCONN. A former health-policy fellow at the Heritage Foundation, he is the author of How to Destroy a Village: What the Clintons Taught a Seventeen Year Old.

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