By Dr. John R. White

(Dr. White is president-elect of the Kentucky Medical Association)

Defensive medicine is a learned response to more than forty years of aggressive and punitive litigation relating to bad outcomes that occur regardless of adherence to Standards of Care and the acceptance of the risks inherent to some medical interventions. The great majority of legal actions against physicians are brought because of unexpected poor outcomes where either a test was not done, a procedure was not "timely", or the treatment was not successfully completed. These accessories to poor outcomes are mitigated or at least diminished by more costly and often redundant interventions that drive up costs. President Obama even recognized the impact of defensive medicine on the cost of healthcare, when he spoke to the AMA earlier this summer.

Frivolous lawsuits are the reason most physicians in this country practice defensively. The threat of litigation is ever present as the physicians make diagnostic and therapeutic decisions, which patients demand to save their lives and keep them healthy. To ensure their patients receive the best care possible yet avoid being sued, physicians have long relied on testing, and the frequent use of higher and more expensive technology, which makes care more costly.

And higher costs are not the only ill effect our overly litigious legal system has on the delivery of healthcare. It also limits access to care. As the Lexington Herald Leader reported in October of 2007, our state, and the nation, has a shortage of doctors. The Kentucky Institute of Medicine released its Physician Manpower Study at that time, indicating the state needs at least 2,300 more physicians to meet national standards. The study also indicated that incredibly expensive medical liability insurance premiums and the constant threat of litigation are significant factors in a physician’s decision to retire early, leave the state, or simply not to go into medicine at all.

When that happens, patients are affected most. They may be forced to travel long distances to see a specialist, experience long waits before they can see their doctor, or, in some cases, they cannot obtain the care they need. This is not efficient health care. It’s clear to most everyone, including the President, that the nation’s broken liability system extracts a heavy toll on the patients and physicians of America. Reasonable reforms that eliminate frivolous lawsuits, reduce healthcare costs, and protect the rights of victims of a preventable medical error are desperately needed. If Congress and state legislatures really want to do something that will have a dramatic affect on the delivery and cost of healthcare in this nation, they should consider medical liability reform as a first step.