On 2017 Feb 19, David Keller commented:

Higher physician spending on medical tests is associated with lower risk of malpractice lawsuit

The observed association of higher physician spending on medical procedures and tests with lower risk of malpractice lawsuits does not seem surprising. In general, the need for a diagnostic test is assessed based on the pretest likelihood of disease, which cannot be determined with perfect accuracy. Playing the percentages in this way works well most of the time, except when it doesn't. All it takes is one missed diagnosis to ruin your whole decade. Even a completely useless test will force the physician to think about the patient, if only briefly, when the result is reported. That additional attention may be enough to trigger thoughts that lead to the correct diagnosis. In addition, there is the possibility that "shotgun" testing may return an informative result due to serendipity. Many effective pharmaceuticals are discovered by indiscriminate screening, and while this method cannot be justified on a cost-benefit-harm basis in clinical medicine, it is sometimes helpful when the approved diagnostic algorithm is stuck in the mud. You can't win the lottery if you don't buy a ticket.

The above comment was published online by British Medical Journal as a "rapid response"; it is included here for the record, for convenience, and for the opportunity to engage readers in the U.S.

Reference:

BMJ 2015;351:h5516 URL: http://www.bmj.com/content/351/bmj.h5516/rr-5

On 2017 Feb 19, David Keller commented:

Higher physician spending on medical tests is associated with lower risk of malpractice lawsuit

The observed association of higher physician spending on medical procedures and tests with lower risk of malpractice lawsuits does not seem surprising. In general, the need for a diagnostic test is assessed based on the pretest likelihood of disease, which cannot be determined with perfect accuracy. Playing the percentages in this way works well most of the time, except when it doesn't. All it takes is one missed diagnosis to ruin your whole decade. Even a completely useless test will force the physician to think about the patient, if only briefly, when the result is reported. That additional attention may be enough to trigger thoughts that lead to the correct diagnosis. In addition, there is the possibility that "shotgun" testing may return an informative result due to serendipity. Many effective pharmaceuticals are discovered by indiscriminate screening, and while this method cannot be justified on a cost-benefit-harm basis in clinical medicine, it is sometimes helpful when the approved diagnostic algorithm is stuck in the mud. You can't win the lottery if you don't buy a ticket.

The above comment was published online by British Medical Journal as a "rapid response"; it is included here for the record, for convenience, and for the opportunity to engage readers in the U.S.

Reference:

BMJ 2015;351:h5516 URL: http://www.bmj.com/content/351/bmj.h5516/rr-5