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1 Defensive Medicine: A Case and Review of Its Status and Possible Solutions Author Affiliation Course Instructor Due Date

2 Defensive Medicine: A Case and Review of Its Status and Possible Solutions: Article Summary The author of the article, Eric D. Katz, examines how malpractice liability systems exist in part to reimburse victims for their losses brought on by medical malpractice, punish offenders, and promote the delivery of high-quality healthcare. According to a general definition of defensive medicine, patient outcomes are less important than the possibility of legal action. One of the main sources of stress for physicians is worry about malpractice, which is primarily fueled by the perception that the malpractice system is unjust, burdensome, and ineffective (Katz, 2019). Physicians frequently overestimate their own risk and the expense of defending themselves, and their perception of malpractice rarely matches the severity of a state's tort system. Defensive medicine probably only represents 2.8% of total healthcare spending, although this is difficult to estimate (Katz, 2019). The phrase "tort reform" is frequently used to promote modifications to the legal system and defensive tactics. Although most of them are unproven and must all be used on a state-by-state basis, safe harbors, clinical practice guidelines, comparative blame reform, lowering plaintiff attorney fees, and apology laws have all been considered workable solutions to defensive practice. The article's conclusion points out that although malpractice has some beneficial social effects, it also stresses doctors and encourages the practice of defensive medicine. As a result, only about 2.8% of medical expenses go toward helping patients; instead, they are used to settle legal disputes. Despite being small in comparison, this sum of money is significant. Tort reform's chances of changing the current system are very slim. Defensive medicine overtaxes the healthcare system with pointless procedures, costing money and depriving patients who may require them of care. Most studies show that tort reform, which restricts compensation for

3 malpractice, lowers the frequency and seriousness of malpractice claims. Costs for malpractice insurance are also reduced. Defensive medicine is the practice of overtreating patients to protect oneself from liability for possible negligence. Medical malpractice is a serious issue that has caused countless patient injuries in the medical field. Such carelessness can leave victims with severe injuries and, in rare circumstances, fatalities. In the event of a fatality, the next of kin may file a lawsuit for rights to due process, giving the victims the ability to seek damages. In a claim where they both have a remote chance of success, the patient and the doctor would be apprehensive about the case's potential outcome and any liability the court might impose (Katz, 2019). Therefore, medical professionals will practice defensive medicine to be safe (Cragle, Strobl, 2022) . Actually, defensive medicine is a reaction to the unreliable past of medical malpractice claims and the unreliable present cost of malpractice insurance in the healthcare industry. Medical professionals now practice defensive medicine to take the necessary precautions safely and lessen the likelihood of being confronted or subjected to action. Most studies reviewed revealed defensive medicine as a common and costly issue (Frierson, 2022) . Doctors only need to adhere to the standards of care necessary for each patient to avoid malpractice. Tort reform is a contentious issue in this nation. Numerous studies have been done on this subject, with varying degrees of success. Tort reform is necessary for some reasons, including the absence of non-economic damages, punitive damages, shortened statutes of limitations, expert witness requirements, attorney fee ceilings, patient compensation funds, and no-fault laws. One of the most severe criticisms of the medical malpractice tort system is the claim that the defense of medical malpractice cases unnecessarily raises healthcare costs in the United

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4 States. Reformers have long argued that the persistent threat of legal action encourages the practice of defensive medicine (the excessive use of diagnostic tests and medical services to reduce a physician's liability exposure) and drives up healthcare providers' prices to cover the costs of rising malpractice insurance premiums. Arguments that medical malpractice tort reform is the most practical method to stabilize malpractice insurance rates and overall lower healthcare costs are still divisive in both the legal and medical communities (Săraru,2018) . No matter how successful tort reform is, medical malpractice litigation will always exist. Each radiology department must focus on reducing risk by creating comprehensive risk management and compliance program to improve the security and standard of care that its radiologists and technologists provide. A crucial component of any program is the ongoing evaluation of the department's quality management practices with a focus on implementing adjustments were necessary to guarantee patient safety, to guarantee the accurate delivery of high-quality care, and enable the imaging department to gain and maintain a competitive edge (Liu, & Hyman, 2020) . The framework of any risk management and quality and performance improvement program will surely alter depending on the size of the radiology department or group. It is generally agreed, however, that any risk management program must, to varying degrees, implement processes to monitor performance, analyze and depict data, and implement change. Besides, such a program must comply with regulatory requirements in patient safety, process implementation and improvement, high-quality and caring customer service, and professional staff education and assessment. Defensive medicine can undoubtedly benefit doctors who want to avoid making mistakes when administering treatments. However, it also results in adverse effects on individuals and the healthcare system. Defensive medicine may benefit certain doctors financially and personally,

5 but it has unfavorable repercussions on other areas of the medical industry, namely the patients. Some of these include the inability to obtain appropriate treatments, the decline in treatment quality, and the increased expense of treatments (India Brand Equity Foundation, 2018) . One of the drawbacks is the inability to obtain appropriate care, which has the unavoidable side effects of time loss, resource depletion, and improper management of hospital resources. There will be less necessary treatment, but it will still be accessible to the general public. Demand is still a high while, at the same time, causing treatment quality to decline. The rising cost of treatment is the following concern. Most medical professionals choose to practice defensive medicine out of serious concerns about the possibility of being sued for medical malpractice, which undoubtedly contributes to the sharp rise in medical costs. As a result, it is clear that during the confusion, the provision of healthcare services is occasionally overshadowed by other goals. Some medical professionals would turn to administer those extra, unnecessary treatments to increase profits and offset rising costs. A different strategy for medical liability reform would let patients and providers agree in advance on the guidelines for how patients would be paid if they suffered an injury due to simple negligence. Contractual responsibility laws may provide more or fewer safeguards than the tort liability laws already established by the courts and legislators. The contract may also modify the level of care used to determine negligence (Liu, Hyman, 2020) . Alternatively, the agreement could include more robust safeguards against carelessness than those currently provided by tort law. Contract liability has economic appeal because competent adults have a range of risk preferences and financial resources. Health care may become unaffordable for low-income patients if all patients are required to accept a uniform amount of malpractice protection. In contrast, others may be forced to "buy" more malpractice insurance than they would like. If

6 physicians have the option to negotiate reduced fees, more low-income patients may be able to pay for healthcare (Sasor, & Chung,2020). It would also cut the cost of care for individuals who expect less protection from negligence than what tort laws mandate. At the same time, contract liability would enable patients afraid of taking chances to negotiate for more protection from carelessness than what is provided by current tort laws. Two implications result when there is uncertainty in the parties' efforts to prove their separate arguments: defensive medicine and the rise in insurance premiums. Defensive medicine is frequently used when doctors find themselves in a precarious and hopeless situation, particularly one that involves rising insurance premium costs and potential damage to their reputation that could result in them losing their medical licenses in the future. The patients end up suffering more as a result of this approach. In the end, the burden of proof shifts to the patient, and it appears that the fight against medical malpractice has reached a dead end. Defensive medicine may be helpful or harmful, depending on the situation. There are unnecessary diagnostic tests, invasive procedures, treatment recommendations, and inpatient requirements in the first category. The latter prevents people from receiving therapy and being admitted to the hospital by forgoing risky operations on patients who would have benefited from them. Both of these practices are increasingly being used in medicine, which raises expenses and occasionally lowers the quality of care. As an illustration, unnecessary, intrusive diagnostic procedures subject the patient to added risks and costs. Modern medicine is significantly influenced by health protocols, but not to the extent of obsession. These are frequently necessary for countries with advanced healthcare systems, even as benchmarks for defensive medicine. The truth is that the protocols do not (or only minimally

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7 do so) take into account each patient's individuality, which is a situation that would call for a personalized, customized, made-to-measure diagnostic approach and therapy. Protocols are not perfect, but they are unquestionably better than the confusion of potentially arbitrary medical decisions. However, they first establish opinions and are not adaptable to specific situations. Thirdly, because the protocols don't always consider the needs of the patients, the doctor-patient relationship can become muddled. For instance, doctors can follow the protocols and treat the glycemia of diabetic patients rather than the diabetic patients themselves, who are different from one another and are unique. Second, they often absolve doctors of accountability; for instance, they can follow the standards and treat diabetic patients' glycemia rather than the diabetic patients themselves, who are distinctive and different from other patients. The protocols go through a laborious, protracted development process, and by the time they are approved and published, they are, by definition, outdated. Several US states have approved tort reforms that limit non-economic damages, binding arbitration panels, and place limits on legal fees. Compared to states without tort reform, those with it had lower awards. There are fewer formal medical lawsuits in Canada and Europe because review committees comprised of experts instead of juries search for actual wrongdoing. Tort reform has drawn criticism for ostensibly removing the patient's right to seek restitution for losses incurred while receiving medical treatment. The desire of society to keep the cost of defense medical and malpractice premiums and awards to a minimum and the right to have a lawyer present their case to a jury of common people are at odds with one another as a result. The pendulum has swung in favor of the more costly jury review system in the United States, in contrast to Canada and Europe, where judgments have favored various organized systems of experts adjudicating claims. As a result of such choice, healthcare prices have soared in the US.

8 Defensive medication often increases the expense of a patient's medical care. There are many reasons why defensive medicine is used, including financial incentives to increase patient care revenues. In some circumstances, this may be required to confirm the diagnosis, determine the severity of the condition, or because the diagnostic tests now available are unreliable enough. However, most doctors' personal wealth or professional reputation is unaffected by a lawsuit since they carry malpractice insurance. Despite this, due to reputational concerns that could jeopardize their standing in the industry, some doctors exhibit symptoms of worry, melancholy, or personality disorders

9 References Katz, E. D. (2019). Defensive medicine: a case and review of its status and possible solutions. Clinical Practice and Cases in Emergency Medicine , 3 (4), 329. India Brand Equity Foundation. 2018. Healthcare sector growth trend. https://www.ibef.org/industry/healthcare-india.aspx. Accessed 15 May 2018 . Medress, Z. A., Jin, M. C., Feng, A., Varshneya, K., & Veeravagu, A. (2020). Medical malpractice in spine surgery: a review. Neurosurgical Focus , 49 (5), E16. Agarwal, R., Gupta, A., & Gupta, S. (2019). The impact of tort reform on defensive medicine, quality of care, and physician supply: A systematic review. Health services research , 54 (4), 851-859. Frierson, R. L., & Joshi, K. G. (2019). Malpractice law and psychiatry: An overview. Focus , 17 (4), 332-336. Mello, M. M., Frakes, M. D., Blumenkranz, E., & Studdert, D. M. (2020). Malpractice liability and health care quality: a review. Jama , 323 (4), 352-366. Liu, J., & Hyman, D. A. (2020). The Impact of Medical Malpractice Reforms. Annual Review of Law and Social Science , 16 , 405-419. Galey, S. A., Margalit, A., Ain, M. C., & Brooks, J. T. (2019). Medical malpractice in pediatric orthopaedics: a systematic review of US case law. Journal of Pediatric Orthopaedics , 39 (6), e482-e486. Frierson, R. L. (2022). The Litigation Process. Malpractice and Liability in Psychiatry , 41-46. Cragle, S. P., & Strobl, G. L. (2022). Malpractice Woes: Here Is What You Should Do if You Get Sued. Otolaryngologic Clinics of North America , 55 (1), 153-160.

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10 Săraru, I. C. (2018). Medical malpractice regulation. Civil, administrative, and criminal liability. Romanian Journal of Ophthalmology , 62 (2), 93. Sasor, S. E., & Chung, K. C. (2020). Litigation in hand surgery: a 30-year review. Plastic and Reconstructive Surgery , 146 (4), 430e-438e. Jordan, J. E., & Flanders, A. E. (2020). Headache and neuroimaging: why we continue to do it. American Journal of Neuroradiology , 41 (7), 1149-1155. Viscusi, W. K. (2018). Medical malpractice reform: what works and what doesn't. Denv. L. Rev. , 96 , 775.

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