Spend more, save more! (Lawsuits, that is)

The Pediatric Insider

© 2015 Roy Benaroch, MD

A November, 2015 study shows that doctors who spend more money are less likely to get sued.

Researchers from Harvard, Stanford, and UCLA looked at data from admissions to Florida hospitals from 2000-2009, examining the rates of lawsuits filed against physicians versus the amount of money spent on the admission. Sure enough, in six of the seven specialties evaluated, there was a clear trend showing that at each step-up in spending, there was as step-down in the rate of lawsuits filed. For instance, in internal medicine the lowest fifth of spenders (~$20,000 for admission) had a 1.5% risk of a lawsuit; the highest fifth (~$40,000) had a risk of .3%. Double your spending, decrease your risk of a lawsuit by five times. Not a bad deal, really, for the doctors.

But was it a good deal for the patients? These investigators didn’t look at outcomes, but overall we know higher spending does not equal better care or healthier outcomes. More spending may seem to increase “patient satisfaction scores”, but high patient satisfaction negatively affects overall health. More tests often lead to the overdiagnosis of conditions that didn’t need to be treated, causing more worry and spending even more money.

So why do some docs spend more than others? This study reinforces the evidence for so-called defensive medicine: tests and procedures done only to ward off lawyers, the way garlic keeps away vampires. But garlic is cheap and harmless, and vampires are, well, imaginary. In the real world, docs are doing unnecessary tests and procedures, harming patients and flying through money, to stay out of the courtroom. Do I blame them? No. Is there a better way? I hope so.


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