Defensive medicine can be defined as “medical care provided to patients solely to reduce the threat of malpractice liability, rather than to further diagnosis or treat.”1 It can either refer to performing more tests or procedures than medically necessary (positive defensive medicine) or avoiding high-risk procedures or high-risk patients (negative defensive medicine).2 Defensive medicine is practiced to some extent by clinicians in many countries, but more so in the United States, which is known to be a particularly litigious environment.2 For example, more than 90% of physicians in Pennsylvania and more than 80% of physicians in Massachusetts reported practicing defensive medicine.1 An estimated $55.6 billion is spent in the United States on medical liability system costs, including defensive medicine, on an annual basis.2,3
A recent study investigates whether defensive medicine actually achieves its goal of reducing malpractice claims.1 The researchers used data on 18,352,391 admissions to acute care hospitals in Florida during the 2000–2009 period and linked them to malpractice history of the attending physicians. The study investigated physicians in seven specialties (internal medicine, internal medicine subspecialty, family medicine, pediatrics, general surgery, surgical subspecialty, and obstetrics/gynecology) to see if those with higher than average hospital charges in a given year were less likely to face an allegation of malpractice during the following year. The researchers adjusted for patient characteristics, comorbidities, and diagnosis. The data included 24,637 physicians and 154,725 physician years.