Is primary care ‘defensive’ medicine?

A new study in the Archives of  Internal Medicine cites the statistic that 28% of primary care physicians are practicing more aggressively than they would like and that 42% of their patients receive too much medical care.   

Fear of a malpractice suit was the most significant factor driving aggressive practice, followed by adherence to clinical practice measures and inadequate time to spend with patients.  Almost half (45%) of the doctors surveyed estimated that at least 10% of the patients they see on a typical day could be managed by a visit with a nurse or an email or phone consultation, although reimbursement for some of these strategies is negligible to nonexistent.

One of the most interesting factors from the survey was that more than 75% of those polled were interested in learning more about how they measured up to other physicians in the community.

What can be done?

There are numerous roadblocks to defusing aggressive medicine.  Changing the medical malpractice system is no small task.   It could be years until doctors are reimbursed for spending more time with patients, or communicating with patients via email or phone.   And the effect of clinical performance measures on aggressive practice has yet to be determined.

While you wait for healthcare reform to wend its way down into clinical practice, Dr. Calvin Chou of the University of California San Francisco suggests two specific approaches you can use now to decrease aggressive practice:  patient-centered communication and mindfulness.   However, it’s obviously going to take more than just good communication skills and an open mind to become a less aggressive PCP.  The reimbursement and malpractice issues loom large and overwhelming.  The good news is that many PCPS recognize the problem and have expressed interest in learning where they stand in comparison with their peers.  That’s an excellent first step.



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