Propelled by mass wariness of malpractice lawsuits, defensive medicine has crossed the Atlantic on a suprising scale.

Echoing a years-long trend well-documented in the U.S., nearly 98 percent of 1,784 Austrian radiologists, orthopedic surgeons and trauma surgeons admit they sometimes over-test and over-treat patients out of fear of malpractice liability.  

The eye-popping percentage was uncovered by a study questionnaire whose results appear in the current issue of the Journal of Evaluation in Clinical Practice.

Study authors Michael Osti, MD, of the Academic Hospital Feldkirch in Austria, and Johannes Steyrer, PhD, of the Vienna University of Economics and Business, introduce their findings by pointing to numerous U.S. studies showing that defensive medicine has been a major concern in the U.S. health care system for decades—and has had a major impact on care quality and access to healthcare services.

“Malpractice liability, current jurisdiction and the increasing claim for accountability … may result in adverse effects on patients’ safety and ethical conflicts as well as deteriorate a confiding relationship between doctor and patient,” they write.

The specifics that Osti and Steyrer present show that, in Austria, between January and May 2014, defensive indications for diagnostic imaging by radiologists often exceeded defensiveness ratings for orthopedic and trauma specialists. For example, during treatments of high-risk patients, 81 percent of doctors requested additional diagnostic procedures for defensive considerations. Time expenditures for defensive practice amounted to 9.2 hours per month in radiology and to 17 and 18 percent of total working time, respectively, in orthopedic and trauma surgery.

“The census of radiologists intended to incorporate the perception of a medical specialty at liability risk but neither interacting nor deciding in direct patient contacts and solely supplying diagnostic data on demand in this context,” they write.

As to how the defensiveness ratings were quantified, the authors explain that radiologists answered questions reflecting estimates of such factors as absolute counts of reports they issued for diagnostic imaging requests from orthopedic and trauma surgeons; assumption of defensively motivated imaging requests or diagnostic imaging with minor significance for patient benefit; and working time needed for the interpretation of radiographs, CT scans, MRI scans and ultrasound exams.

Also added into the scoring mix were prior confrontations with malpractice liability claims, along with individual rating of increasing, consistent or decreasing trends in defensive practices.

The prevalence of defensive medicine “represents a serious challenge in Austria,” they conclude. “Our results indicate the urgent necessity for confrontation with and solution for the increasing effort of self-protection within the health care system.”

While regrettable when considered purely from an appropriate-use standpoint, U.S. radiologists’ defensive posture is also understandable.

In a 2012 project funded through an RSNA educational grant and presented to the American College of Radiology, David M. Yousem, MD, MBA, director of neuroradiology at Johns Hopkins, showed that radiologists have a 1 in 3 chance of being sued each year—and lose one-third of all malpractice claims filed against them. Yousem also reported that the average cost for a radiological malpractice insurance policy is $13,000.

Meanwhile a 2013 study published in Radiology and led by Jeremy Whang, MD, of the University of Medicine and Dentistry of New Jersey (now a part of Rutgers University), showed that errors in diagnosis are, far and away, the most common generic cause of malpractice suits against radiologists.

Click here to access the Austrian study, here for the Yousem presentation (PowerPoint download) and here for the Whang study.