Malpractice fears drive docs to order excess tests

NEW YORK (Reuters Health) - In evaluating patients who have chest pain, some emergency room physicians too often order unnecessary tests and hospitalizations out of fear of malpractice lawsuits, according to a new study. "Concern about malpractice has a formidable effect on physician decision making," particularly in the scenario of a possible heart attack or unstable angina, collectively referred to as acute coronary syndrome, Dr. David A. Katz told Reuters Health.

Katz, from University of Iowa, Iowa City, and colleagues developed a malpractice fear scale and used it to evaluate the association between emergency physicians' fear of malpractice and the evaluation and treatment of patients with symptoms suggestive of an acute coronary syndrome.

The findings are reported in the online issue of Annals of Emergency Medicine.

Patients seen by ER doctors with the highest scores on the malpractice fear scale were significantly less likely to be discharged from the emergency room than were patients seen by ER doctors with the lowest scores, the authors report. The trend persisted when only low-risk patients were included in the analysis.

Physicians with the highest malpractice fear scores were also more likely to admit patients to monitored beds and to order laboratory tests and chest X-rays in the emergency room, the report indicates.

Among patients with confirmed acute coronary syndrome, the researchers note, the proportion with emergency room diagnoses indicating a low suspicion of ACS did not differ significantly based on physicians' malpractice fear scores.

"Malpractice fear accounts for significant variability in emergency department decision-making that is not explained by general risk aversion and is associated with increased hospitalization and use of diagnostic tests in patients with possible acute coronary syndrome," the team concludes.

"Our findings that high-fear physicians are more likely to admit patients with symptoms of possible acute coronary syndrome (including low-risk patients) and to obtain more diagnostic tests in these patients suggest that the initial costs of care are quite a bit higher for this group of physicians," Katz said, "but this needs to be confirmed with a formal analysis of initial and follow-up medical costs."

SOURCE: Annals of Emergency Medicine, July 13, 2005.