Malpractice insurance costs are based on loss experience and defenses of expenses. Physicians in the high-risk category are in that position because, as a group, they have a high frequency of claims, a high average cost, or both.
True, "defensive medicine" is the best way to minimize the risks. This does not mean ordering unnecessary tests or refusal of essential treatment. Rather, it is the habit of exercising extra care and foresight to avoid medical hazards and to apply prompt remedial measures when they occur. It means being aware of the patient's personality and needs. It means taking time to talk to the patient about proposed procedures and their risks. This kind of "defensive medicine" offers the best hope for reducing the frequency and cost of claims that result in the present critical malpractice problems.
Bergen RP. Protection Against Malpractice Litigation. Arch Otolaryngol. 1975;101(3):182–184. doi:10.1001/archotol.1975.00780320040009
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