Rising lawsuit threat puts nervous doctors to the tests
To avoid getting sued, doctors now take extra precaution by doing unnecessary, and costlier, tests
Consumers are paying more for medical treatment because doctors do unnecessary tests on patients to avoid losing lawsuits, according to the Medical Protection Society (MPS).
Medical negligence lawsuits are increasing, as are the payouts awarded to injured patients. This changes the way doctors practise medicine and ultimately hits patients’ wallets, Africa division head of MPS Graham Howarth told Times Select.
Healthman Consultancy spokesperson Dr Johan Serfontein, who works for various doctors’ societies, explained what defensive medicine was.
“Realistically, one might not include certain tests in a normal test battery, but due to patients suing doctors so often these days, they are done. This would include tests that are not typical, due to a malpractice lawyer asking why such a test was not done.”
Sometimes patients are to blame because they use Dr Google and then pressure doctors for extra tests.
Serfontein said: “Patients are also more likely to Google search symptoms and medical conditions, and are therefore more likely to request tests and procedures that rule out obscure diseases.”
A recent survey of 500 local doctors by the Medical Protection Society (MPS), a nonprofit organisation that offers a type of insurance to health workers, found almost half admitted to practising defensive medicine.
MPS has seen a 57% increase in the number of medical negligence claims reported between 2008 and 2017. “It is therefore not surprising that doctors are practising defensively to reduce their risk of receiving a complaint or claim. However, overcautious doctors are not less likely to receive a clinical negligence claim.”
He urged doctors to communicate well with patients to prevent disgruntled patients who wanted to sue.
Howarth said payouts for those had increased by more than 40% for the same period.
The Discovery Health medical aid administrator has data on more than 2.7 million medical aid members and suspects some tests are done purely to avoid lawsuits.
Discovery head of quality care Dr Roshini Moodley-Naidoo said: “Diagnostic tests such as MRI and CT scans incur unusually high-cost increases each year, higher than to be clinically warranted. Similarly, pathology costs are increasing rapidly each year.
“These trends may indicate some element of defensive medicine.”
Moodley-Naidoo said doctors working alone felt they had no choice but to do a C-section. It is harder for an obstetrician to manage all patients who go into labour doctor if they are unscheduled.
The law prevents doctors being paid for working in a team.
“We believe that the unusually high Caesarean-section rate in the private sector is driven by a few significant factors, one of these being the punitive malpractice environment. Obstetricians, who generally practise alone, rather than in teams, are anxious to allow trials of natural labour, for fear of the legal implications should the birth result in a poor outcome. This is a very serious issue and requires urgent attention to support doctors who are turning away from practising obstetrics for fear of malpractice litigation.”
If the extra tests are not being paid for by the patient, the huge negligence payouts of millions are also passed on to the consumer since doctors and hospitals have to cover high insurance fees.
Bonitas medial aid said that looking at the data “there is evidence that alludes to the practice of defensive medicine”.
It said C-sections are one of most common forms of defensive medicine and this costs the medical aid a lot.
“The reality of litigation and spiralling costs of indemnity fees for obstetricians is a national crisis threatening the viability of private practice obstetrics in SA.” it said.
“The Bonitas C-section rate has been on the rise since 2010.”
About 750 babies are born each month on Bonitas – two out of three are being delivered by C-section.
It is the most costly admission category and third-most-frequent case for 2017, accounting for 4 % of hospital costs said Bonitas.
The starting cost of insurance for a private obstetrician was R850,000 a year it said, which has increased 600% since 2009.
A study by professor Ethelwynn Stellenberg of the department of nursing and midwifery at Stellenbosch University’s faculty of medicine and health sciences found the contributing factors to malpractice cases were usually nurses’ failure to follow guidelines and poor monitoring of patients.
“The quality of care is declining, in both the state and private sectors,” she warned, saying nursing just wasn’t good enough.
She said the payouts are increasing. It amounts to payouts of millions. “In the end these costs are passed on to the consumer,” Stellenberg said.
She and two students asked private hospitals for legal records. They denied her access on the advice of their legal teams. She then approached medical negligence attorneys. “Fortunately, many of them saw the need for this research,” said Stellenberg.
A total of 122 completed cases were studied, a fifth of which resulted in patient deaths.
In all, 74% of the cases were settled out of court.