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Is the Defensive Use of Diagnostic Tests Good for Patients, or Bad?

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  • Michael L. DeKay
  • David A. Asch

Abstract

Physicians sometimes order diagnostic tests to reduce the risk of malpractice liability. The authors develop an expected-utility model that links a rational physician's concerns about malpractice liability to increases in the use of diagnostic tests and use this model to assess the effects of defensive testing on patients' interests. To do so, they adapt the threshold approach to clinical decision making to incorporate the physician's inter ests, focusing on 1) the effect of the physician's expected liability risks and 2) the effect of any expected liability reduction due to diagnostic testing. Surprisingly, the mere existence of liability risks is often sufficient to widen the range of disease probabilities for which diagnostic testing is the preferred clinical strategy. If testing reduces the physician's expected liability risks, the testing range is widened further. For some dis ease probabilities, testing is preferred by the physician even though it is not in the patient's best interests. When tests are performed in such instances, utility is trans ferred from the patient to the physician and the physician's insurer. Although the de fensive use of diagnostic tests improves clinical outcomes for some patients, it worsens clinical outcomes for others. Moreover, defensive testing worsens the expected out comes of all patients whose clinical strategies are changed. Physicians should realize that defensive testing necessarily reduces the overall quality of patient care. Key words: decision analysis; decision threshold; defensive medicine; diagnostic testing; expected utility; malpractice liability. (Med Decis Making 1998;18:19-28)

Suggested Citation

  • Michael L. DeKay & David A. Asch, 1998. "Is the Defensive Use of Diagnostic Tests Good for Patients, or Bad?," Medical Decision Making, , vol. 18(1), pages 19-28, January.
    • Handle: RePEc:sae:medema:v:18:y:1998:i:1:p:19-28
    DOI: 10.1177/0272989X9801800105
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    References listed on IDEAS

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    1. Brian E. Forst, 1974. "Decision Analysis and Medical Malpractice," Operations Research, INFORMS, vol. 22(1), pages 1-12, February.
    2. Harold Bursztajn & Robert M. Hamm & Thomas G. Gutheil & Archie Brodsky, 1984. "The Decision-Analytic Approach to Medical Malpractice Law," Medical Decision Making, , vol. 4(4), pages 401-414, December.
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    Citations

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    Cited by:

    1. Michael Osti & Johannes Steyrer, 2017. "A perspective on the health care expenditures for defensive medicine," The European Journal of Health Economics, Springer;Deutsche Gesellschaft für Gesundheitsökonomie (DGGÖ), vol. 18(4), pages 399-404, May.
    2. Keller, Elena & Ortmann, Andreas & Chambers, Georgina Mary, 2024. "Exploring the demand for elective egg freezing: A laboratory experiment," Journal of Behavioral and Experimental Economics (formerly The Journal of Socio-Economics), Elsevier, vol. 111(C).
    3. Tritter, Jonathan Q. & Lutfey, Karen & McKinlay, John, 2014. "What are tests for? The implications of stuttering steps along the US patient pathway," Social Science & Medicine, Elsevier, vol. 107(C), pages 37-43.
    4. Iztok Hozo & Benjamin Djulbegovic, 2009. "Will Insistence on Practicing Medicine According to Expected Utility Theory Lead to an Increase in Diagnostic Testing? Reply to DeKay's Commentary: Physicians' Anticipated Regret and Diagnostic Testin," Medical Decision Making, , vol. 29(3), pages 320-324, May.
    5. Michael L. DeKay, 2009. "Physicians' Anticipated Regret and Diagnostic Testing: Comment on Hozo and Djulbegovic, 2008," Medical Decision Making, , vol. 29(3), pages 317-319, May.
    6. Tinglong Dai & Shubhranshu Singh, 2020. "Conspicuous by Its Absence: Diagnostic Expert Testing Under Uncertainty," Marketing Science, INFORMS, vol. 39(3), pages 540-563, May.
    7. Ogden, Benjamin G. & Hylton, Keith N., 2020. "Incentives to take care under contributory and comparative fault: The role of strategic complementarity," International Review of Law and Economics, Elsevier, vol. 61(C).

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