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Three-fourths of physicians overtest due to malpractice threat.

The vast majority (75 per cent) of American doctors say the threat of malpractice suits leads them to order laboratory tests that otherwise are not needed.

This was one of the key results of a recent Gallup poll commissioned by the American Medical Association. The survey was conducted earlier this year and reported in the June 23-30 issue of American Medical News.

In the poll of 1,004 physicians, 75 per cent said they ordered extra tests for defensive purposes; 22 per cent said they didn't; and 3 per cent were unsure (Figure 1).

Interestingly, a smaller percentage of the general public thought doctors engaged in defensive testing. In a companion Gallup poll of 1,500 U.S. adults, only 61 per cent said yes, doctors do too many tests because of the fear of malpractice suits; 31 per cent said doctors didn't; and 8 per cent were unsure (Figure 1).

While many physicians are reacting to liability fears by ordering extra tests, others-a minority-are declining to take on highrisk patients due to liability concems . The survey showed that 76 per cent of doctors continue to provide services to high-risk patients despite the fear of malpractice lawsuits. But 14 per cent said they had refused service for fear of lawsuits 10 times or less in the last year, and 4 per cent said they had refused service more than 10 times.

Five per cent said this question didn't apply to them because they had not encountered high-risk patients in the last 12 months, and 1 per cent were unsure.

When it came to who was most likely to bring a suit, 39 per cent of physicians believed indigent patients are more likely than nonindigent patients to sue for malpractice; 31 per cent said it made no difference whether the patient was indigent; 22 per cent said indigent patients were less likely to sue; 4 per cent said they did not see indigent patients; and the remaining 4 per cent were unsure.

"I believe it is a critical comment on the state of our legal system that even one patient would not receive care because physicians feared being sued," said James H. Sammons, M.D., executive vice president of the AMA. "All of these factors-declining high-risk patients, limiting their type of practice, and believing indigent patients are more likely to sue-impact on the public's ability to receive medical care."

Almost half (48 per cent) of the general public believe that people who sue physicians for malpractice are just looking for an easy way to make money. Only 27 per cent believe that malpractice suits are usually justified, and 25 per cent are unsure.

More than half (54 per cent) of the public think juries award too much money in malpractice cases; 6 per cent said the awards were too small; 24 per cent said they were about right; and 16 per cent were unsure.

Last, 62 per cent of the public favor a ceiling for "pain and suffering" awards; 26 per cent oppose a ceiling; and 12 per cent are unsure.

"When you combine excessive awards, no limits on 'pain and suffering' awards, and legally necessary but medically unnecessary tests, you see three major contributors to the rising costs of medical care in the U.S.," said Dr. Sammons.
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Author:FitzGibbon, Robert J.
Publication:Medical Laboratory Observer
Article Type:editorial
Date:Sep 1, 1989
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