On June 6, 2018, JAMA Cardiology published the results of a study that analyzed “the association of damage caps with specific cardiac care decisions that involve clinical uncertainty, high patient risks, and significant malpractice risk.” The study “found evidence that physicians altered their CAD [coronary artery disease] testing and intervention practices following adoption of damage caps. Overall testing rates did not change, but testing became less invasive (fewer initial angiographies and less progression from initial stress test to angiography), and revascularization through PCI following initial testing declined. These findings suggest that physicians are willing to tolerate greater clinical uncertainty in CAD testing and treatment if they face lower malpractice risk.”
The study’s objective was “To examine whether reducing malpractice risk is associated with clinical decisions involving coronary artery disease testing and treatment” and sought to answer the question, “Do physicians change testing and treatment decisions for coronary artery disease after malpractice reform?”
The study found that “physicians in the 9 states that adopted damage caps between 2002 and 2005 performed a similar number of ischemic evaluations for possible CAD but performed fewer initial invasive coronary angiography and more noninvasive stress tests relative to control physicians. Physicians in states that adopted damage caps also referred fewer patients for angiography following a stress test, and fewer patients progressed from evaluation to revascularization.”
The study’s authors concluded: “These findings provide evidence that physicians who face lower malpractice risk tolerate greater clinical uncertainty in testing for and treating CAD … Although there is little evidence that malpractice reform affects overall health care spending, it may influence physician behavior for specific conditions involving clinical uncertainty.”
The study’s authors noted: “Physicians frequently report practicing defensive medicine, including ordering marginally beneficial tests and interventions, to reduce malpractice liability. Imaging and invasive diagnostic studies are often cited as overused defensive measures … Although early work by Kessler and McClellan found that damage caps led to a 4% to 5% drop in hospital spending following a heart attack, later studies have not found significant changes in health care spending after cap adoption.”
Perhaps the medical community needs to inform patients that their medical care decision-making may be influenced by their own perceived risk of being sued for medical malpractice if their medical decisions injure their patients because they failed to order a certain diagnostic medical test or procedure. Perhaps informed consent laws should require medical providers to engage in a full discussion with their patients regarding their medical malpractice tort reform views and how such may affect their decison-making, and to advise patients regarding the availability of medical tests and why such tests are not being offered to them.
If you or a loved one may have suffered serious injury or other harm as a result of negligent cardiac care in the United States, you should promptly find a medical malpractice lawyer in your state who may investigate your medical malpractice claim for you and represent you or your loved one in a medical malpractice case, if appropriate.
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