Defensive medicine and tort reform are frequently discussed as inseparable twins. Many doctors claim defensive medicine is the systemic evil causing health care costs to run rampant. The latter, tort reform, is the holy grail of health care salvation. Both views are wrong.

Rahul Parikh, MD is a physician who largely agrees with me. In a recent article over at Salon.com Dr. Parikh addresses the fallacy of tort reform.

In contrast to many of my colleagues I attribute defensive medicine to physician incompetence or ignorance. In short, physicians practice “defensive” medicine primarily because they haven’t the knowledge to actually understand the relative likeliness of disease states in particular patient populations. From my own experience at a tertiary care childrens’ hospital I recall pediatricians ordering monthly MRI scans to follow children for “static encephalopathy.” When I inquired one day as to why the response was “just to be sure.” Disquieting. My colleagues in the primary care specialties order tests for diseases with remote, absurdly remote, possibilities. They do this so they can “be sure.” They order tests as a huge battery of unnecessary studies rather than sequentially. They order tests they can’t interpret since they had no meaningful clinical suspicion. They attribute this to “defensive medicine.” It is not defensive. It’s wasteful.

Then we have tort reform. Obama is right to decouple tort reform from health care reform. Proponents of tort reform cite decreased malpractice as the primary metric. They then theorize that decreased malpractice costs will allow health care costs to decrease. Needless to say the reasoning is flawed. There are few, if any, good studies liking malpractice costs to health care costs. In short the pundits are using the wrong metric. Until tort reform can be clearly shown to decrease health care costs then it amounts to little more than an additional route to profit for physicians and liability carriers.

These are complex issues poorly understood by most physicians.

As patients each of you can control health care costs. Simply ask your physician “what is the likelihood that I have the disease you’re looking for?” If the likelihood is very low then look elsewhere- for a diagnosis and health care. If your physician can’t explain, clearly, how (s)he will interpret the test results then look elsewhere.

It’s your health. Take care and take charge.