Malpractice Fears May Lead to Unneeded Heart Tests

Survey shows some cardiologists order cardiac catheterization because of such fears

WEDNESDAY, April 14 (HealthDay News) -- Among cardiologists, variability in the propensity to test and treat partly contributes to regional variation in the utilization of general health and cardiology services, but the factor most closely associated with this propensity is fear of malpractice suits, according to a study published online April 13 in Circulation: Cardiovascular Quality and Outcomes.

Frances Lee Lucas, Ph.D., of the Maine Medical Center in Portland, and colleagues surveyed 598 cardiologists nationwide, gave them hypothetical patient vignettes, and assigned them a Cardiac Intensity Score based on their self-reported recommendations for high-tech or invasive tests and treatments. They also queried respondents as to what circumstances they would order cardiac catheterization "for other than purely clinical reasons."

The researchers found that the Cardiac Intensity Score was associated with two measures of population-based health care utilization measured within geographic regions: general health care spending (which had the strongest association) and delivery of cardiac services. They also found that more than 27 percent of respondents reported ordering cardiac catheterization because of perceived peer pressure, and that nearly 24 percent reported doing so out of fear of malpractice suits. Although both of these factors were significantly associated with the propensity to test and treat, only fear of malpractice was associated with regional utilization.

"We identified some nonclinical factors that influence physician recommendations, but much work remains to identify others. Our results suggest that malpractice concerns may be a target for intervention to reduce variations," the authors conclude.

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