More Evidence that Medical Malpractice Reform Wouldn’t Stop Excessive Testing

As discussed recently (Let’s not forget patient safety in med mal reform) I don’t buy the idea that excessive testing is mainly attributable to “defensive medicine,” i.e., doctors doing too much for fear of frivolous lawsuits. Rather, there are other reasons for ordering unneeded tests, such as profit motive on the part of the doctor or hospital, a desire for more information for decision making, habit, lack of familiarity with low-tech techniques, patient preference, and diagnostic company sales efforts. If med mal reform happened tomorrow, I’d be willing to bet plenty of excessive testing would still occur and that some other excuse would be given to explain it. Only payment reform, provider education and changes in patient demand are likely to make a big difference. An article out today (Follow up lacking on a majority of hospital tests) in FierceHealthcare adds credence to my assertion.

Follow up on patient tests is often poor, according to a review of international studies, an article published in BMJ Quality and Safety reports. Up to 61 percent of inpatient test results and 75 percent of tests on ER patients saw no follow up after discharge, the researchers found.

Poor or inadequate care of patients after discharge can have serious implications for patients, among them missed or delayed diagnoses, or even death. For hospitals, when a patient’s transition to outpatient care features poor test follow-up, a readmission down the road is possible. Providers that order tests and don’t follow them up open themselves up to charges of negligence. If they really ordered the tests as a defensive practice to reduce liability, wouldn’t they make sure someone followed up on the results rather than leave themselves vulnerable to lawsuites? It’s unreasonable to expect all tests to be followed up. After all, sometimes the information is irrelevant by the time it’s received. And communications across settings are notoriously poor. Still, the percentage not followed up seems awfully high.