This spring, a number of studies and surveys have drawn attention to an emerging problem in the healthcare industry – care that is dictated not by medical necessity, but by fear of litigation, in short, defensive medicine. As we all know, correlation is not causation, so more rigorous analysis is needed, but emerging evidence suggests that the main driver of the surge in unnecessary care is fear of litigation.


An article in the February 2015 issue of Neurosurgery, “Defensive Medicine in Neurosurgery: Does State-Level Liability Risk Matter?,” found that neurosurgeons are acutely aware of their liability environment, and that they conform their practice to it.


Neurosurgeons’ perceptions of their state’s liability environment generally corresponded well to more objective measures of state-level liability risk because 83% of respondents correctly identified that they were practicing in a high-risk environment. When controlling for surgeon experience, income, high-risk patient load, liability history, and type of patient insurance, neurosurgeons were 50% more likely to practice defensive medicine in high-risk states compared with low-risk-risk states (odds ratio: 1.5, P < .05).


It’s not just neurosurgeons who are sensitive to liability risks. Another article reports that emergency room doctors cited liability fears the main reason why they order imaging tests that may not be medically necessary.


Anecdotal evidence on the causes of defensive medicine has pointed the finger at liability for years, but hard data on the subjective or objective link between liability and defensive medicine is just now becoming available.


As one of the most expensive states in the nation when it comes to medical liability costs, New Jersey policy makers should pay close attention to this new research.