When a patient shows up at a doctor's office with a bruise after falling and bumping his head, the physician might order a CT scan even if she believes the injury is superficial.
Worries about a malpractice lawsuit might prompt her to take steps that aren't medically necessary. "If I don't get a CAT scan, this is that one case where I'll end up in court," the doctor might think, says Cecil Wilson, a physician who is president-elect of the American Medical Association.
This is defensive medicine -- a careful, fretful approach to treating patients, in which doctors authorize tests in part to reduce the risk that they will be sued. In the national debate over health care, doctors and policy makers often point to spending on defensive medicine as a key driver of soaring costs.
This is a huge deal. There have been several instances where a doctor's suggested an MRI for me "just to make sure" where "watchful waiting" would have been perfectly adequate. (I once learned from an MRI that I had a sinus infection, even though that wasn't at all related to the initial problem.) The MRIs would have (and some did) greatly increased the cost of care and would not have changed the outcome.
Until we get a handle on medical malpractice and our litigious society, the cost of care will remain high.