Physicians' views on defensive medicine: a national survey.

O veruse of health care services, which is frequently cited as a major driver of uncontrolled health care spending, has received considerable attention by policy makers as they debate health care reform. There is a variety of causes for overuse of health care services, but few appear to inspire as much contention as the issue of malpractice. The pervasiveness of malpractice litigation is believed to lead to defensive medical practices, whereby physicians order tests or procedures in excess of their actual need to protect themselves from the risk of lawsuits. Malpractice concerns could have an impact on health care reform efforts to improve efficiency and quality in health care, such as the promotion of the use of comparative effectiveness data, if physicians believe that following comparative effectiveness-based guidelines leaves them vulnerable to malpractice suits. We conducted a national survey of physicians to better gauge the potential impact of malpractice concerns on clinical practice in the context of health care reform.