By Dr. OGLESBY YOUNG For the Monitor
…Look no further than my specialty of obstetrics for a good example of defensive medicine. Our country's cesarean section rate in 1970 was 5 percent. Today more than 30 percent of births are by cesarean section. Babies have not grown that much bigger! And, remarkably, the incidence of cerebral palsy has not changed during the 35 years of increasing cesarean section rates. Good science has shown that less than 10 percent of cerebral palsy has anything to do with events during labor and delivery. Regrettably, obstetricians have learned that our liability for the outcome of a birth is markedly reduced by performing a c-section. As one of my colleagues said, "We are never sued for the cesarean section we have done, but when we are sued it is often for the c-section we did not perform."
Calculating the actual costs of defensive medicine is difficult. Physicians have a hard time saying how much any given decision is driven by liability concerns. Doctors do get sued for failure to diagnose when not ordering tests, but our decisions are mixed with the desire to provide patients with the "best" evaluation and to please patients who want to feel that treatment is comprehensive. And in some cases, doctors increase their income by ordering more tests.
Many factors influence the amount of health care that is provided. Still, defensive medicine alone is estimated to contribute 15-30 percent to the total U.S. health bill. Defensive testing can lead to unnecessary, expensive and serious medical intervention. These hidden costs of our medical malpractice system are an important piece of the puzzle in our country, where health costs per capita are twice that of any other developed nation, despite worse outcomes than most other developed countries…