Defensive medicine drives ED physician imaging overutilization

Emergency room doctors are ordering CT and MRI exams that may be unnecessary because of fears of malpractice lawsuits, according to an article in the journal Academic Emergency Medicine.

The study, led by Hemal K. Kanzaria, MD, an emergency room physician at the University of California Los Angeles, was based on a survey of 435 emergency physicians.

Of those 435 physicians, 85% believe that too many diagnostic tests are ordered in their departments. In addition, 97% said that at least some of the advanced imaging studies they order are medically unnecessary.

Why? The survey respondents said they were afraid of missing low-probability diagnoses, as well as malpractice litigiation.

The survey respondents said that solutions that could  be “extremely” or “very” helpful in reducing unnecessary imaging in emergency departments included malpractice reform (79%), increased patient involvement through education (70%) and shared decision-making (56%), feedback to physicians on test-ordering metrics (55%), and improved education of physicians on diagnostic testing (50%).

“We need to be more cognizant of the culture within and outside of medicine that contributes to over-testing, and we need to address these systems and drivers,” Kanzaria told Time Magazine. “That’s what I hope will result from this work.”