Cardiologists' fears of malpractice suits may contribute to the regional differences in cardiologists' tendency to prescribe tests and treatments for patients' problems, according to a recent study by a team that included two Dartmouth professors, "Variation in Cardiologists' Propensity to Test and Treat," published in the journal Circulation: Cardiovascular Quality and Outcomes. Physicians also consider how they expect colleagues would respond given the same situation before they decide whether to administer cardiovascular procedures, the study found.
The study's authors suggested that variation among regions' malpractice laws may explain why cardiologists administer such procedures more often in certain areas of the country.
Researchers from Dartmouth Medical School and the Dartmouth Institute for Healthy Policy and Clinical Practice along with experts at the Center for Outcomes Research and Evaluation at Maine Medical Center, the Veterans Affairs Medical Center, the Center for Survey Research at the University of Massachusetts at Boston and Health Dialog Analytic Solutions contributed to the study.
Cardiovascular surgeons in certain regions may recommend unnecessary cardiac catheterization, a potentially dangerous cardiovascular procedure, to avoid potential malpractice suits, according to the study. The study also found that cardiologists considered how their colleagues would address the same situation as they decided whether to administer such procedure.
DMS assistant professor Brenda Sirovich and adjunct associate professor David Wennberg, as well as several other researchers, surveyed 598 cardiologists from various regions of the country. The study asked participants how often they would recommend a procedure or test for "non-medical reasons" and what outside factors might compel them to do so.
"We said how often for non-clinical reasons,'" Frances Lee Lucas, an epidemiologist at the Maine Medical Center and co-author of the study, told HealthDay News. "We didn't want to say unnecessary,' because we knew nobody would ever say they ordered an unnecessary test."
While the cardiologists offered a variety of reasons for choosing to recommend a procedure for non-medical reasons, one of the leading responses, which was given by 24 percent of those surveyed, was to avoid malpractice suits.
The study divided regions into groups based on their intensity score, which was assigned based on how aggressively physicians in a given region tend to treat cardiovascular patients.
While 35 percent of respondents in high-intensity regions said they might recommend the procedure because of fear of malpractice suits, only 12 percent of respondents in low-intensity regions gave the same response, according to the study.
The study concluded that despite the variety of reasons respondents provided to justify treatments, only fear of malpractice suits was tied to the variation among regions.
"Malpractice concerns seem to be the common denominator in each analysis and may provide a reasonable target for intervention," the study read.
Before the researchers began their work, other studies had found that factors including resource supply contribute to variation among regions in test utilization rates, according to the study. The current study, however, showed that physicians' attitudes must also be examined.
The other leading factor influencing cardiologists' decisions to recommend the procedure for non-medical reasons was whether they felt a colleague would recommend the procedure in the same situation. According to the study, 27 percent of respondents said they would recommend the procedure if they believed a colleague would do so in the same situation.
Less than 1 percent of respondents said they would recommend the procedure because of the added income they could earn by performing the procedure, according to HealthDay News. Lee said this finding was not surprising.
"I was astonished that anyone said it, but a few did," Lee told HealthDay News.
Sirovich and Wennberg could not be reached for comment by press time.
