Defensive Medicine: Cautious Or Costly?

RICHMOND, Va., Oct. 22, 2007
(CBS) It started as a simple stomach ache, but Alexandra Varipapa, a sophomore at the University of Richmond, decided to go to the emergency room. There, doctors ordered a full CT scan, a radiation imaging test, which found a harmless ovarian cyst. She never questioned the CT scan, CBS News correspondent Wyatt Andrews reports. But her father did - when he got the $8,500 bill, $6,500 of which was that CT scan. “I was pretty flabbergasted,” said Robert Varipapa, himself a physician. Varipapa says his daughter's pain could have been diagnosed far more easily and cheaply with a $1,400 ultrasound. “A history, a pelvic examination and probably an ultrasound,” he said. And he would have started with the ultrasound. But the hospital defends the CT scan, saying an ultrasound might have missed something more serious. “It would not have ruled out appendicitis obviously, it would not have ruled, necessarily, out a kidney stone,” said Dr. Bob Powell, ER medical director of Bon Secours St. Mary’s Hospital. Varipapa agrees, but asks why not start simple - and do the CT scan only if necessary? “Well it's my opinion this is defensive medicine,” Varipapa said. Defensive medicine is what happens when doctors order too many tests because they are afraid of missing a diagnosis and later losing a multi-million dollar lawsuit for malpractice. Defensive medicine these days is so pervasive, some estimate its yearly cost at more than $100 billion. Dr. Kevin Pho runs the popular medical blog, Kevin M.D., where doctors routinely confess exactly how they run up costs by practicing defensive medicine. “Defensive medicine is bad medicine,” Pho said. In a post, one ER doctor says he's just admitted two patients to the hospital - when he was sure "neither was having cardiac (problems), but what am I to do?" Another admits that in his practice, “every patient with a headache gets a (CT) scan.” “It's much easier to defend the fact that you ordered a test than it is to not order the test at all,” Pho said. And the costs of defensive medicine today are increasingly paid by patients, even those with insurance - because of rising deductibles and co-payments. “There’s no doubt in my mind this is a significant driver in health care costs today,” Pho said.