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Research Letter
November 2014

The Cost of Defensive Medicine on 3 Hospital Medicine Services

Author Affiliations
  • 1Center for Value-Based Care Research, Medicine Institute, Cleveland Clinic, Cleveland, Ohio
  • 2Howard University College of Medicine, Washington, DC
  • 3Division of Outcomes and Effectiveness, Department of Public Health, Weill Cornell Medical College, New York, New York
  • 4Division of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
  • 5Division of Academic Affairs, Baystate Medical Center, Springfield, Massachusetts
  • 6Department of Medicine, Baystate Medical Center, Springfield, Massachusetts
  • 7Center for Quality of Care Research, Baystate Medical Center, Springfield, Massachusetts
JAMA Intern Med. 2014;174(11):1867-1868. doi:10.1001/jamainternmed.2014.4649

The overuse of tests and procedures because of fear of malpractice litigation, known as defensive medicine,1 is estimated to cost $46 billion annually in the United States,2 but these costs have been measured only indirectly. We estimated the cost of defensive medicine on 3 hospital medicine services in a health system by having physicians assess the defensiveness of their own orders. We hypothesized that physicians who were concerned about being targeted by litigation would practice more defensively and have higher overall costs.

This study was approved by the institutional review board of Baystate Medical Center. We studied hospitalists at 1 tertiary care (Baystate Medical Center) and 2 community hospitals (Baystate Franklin Medical Center and Baystate Mary Lane Hospital). All hospitalists (n = 42) were invited to complete a survey regarding demographic information and attitudes toward defensive medicine. We then showed physicians their orders placed the previous day and asked them to indicate the extent to which each represented defensive medicine—tests, procedures, or hospitalization ordered primarily because of concern about malpractice liability—using a 5-point scale from 0 (not at all defensive) to 4 (completely defensive). Itemized order costs including daily room and board costs were obtained from the hospital’s cost accounting system.