Recently, a study published in Circulation: Cardiovascular Quality and Outcomes suggested that doctors may order unnecessary medical tests, fueled by fear of possible malpractice suits. Researchers surveyed more than 500 cardiologists throughout the nation about what non-clinical reasons might encourage them to recommend certain cardiac tests. The practice, otherwise known as defensive medicine, is, at its core, the practice of ordering tests that are not medically indicated in order to protect a physician from his or her own fear of litigation, and is often cited as a major force behind rising healthcare costs.

I am consistently amazed when doctors unabashedly acknowledge that they order tests that are not medically indicated for their own financial and psychological benefit, rather than the medical needs of their patient. This unethical behavior is exacerbated by the recent revelation that some five thousand echocardiograms at Harlem Hospital were not even read after having been ordered and performed.

In short, these physicians are being paid to perform unnecessary tests and are using the convenient excuse of an imaginary “fear” of lawsuits for this fraudulent behavior. If the test is not indicated, the taxpayers should not be forced to bear the burden of easing the physicians’ fears. If the test is indicated, the physicians should order the appropriate test and not seek to blame the tort system for that need. The tort system is the only recourse for tens of thousands of patients injured by avoidable medical errors every year and the medical profession spends millions of dollars every year lobbying Albany to take even that recourse away from the victims of medical negligence, the effect of which would be a complete lack of accountability for the acts of medical professionals.

The effort by physicians and insurance companies to blame the victims of their errors for the cost of care is reprehensible. The key to lowering costs is simply to promote patient safety and reduce mistakes – and there are several possible approaches to take:

1. HMO’s and insurance companies need to stop practicing medicine. Too often these companies set limitations on hospital visits and inform physicians which tests they can and cannot perform, all to cut costs.

2. If a doctor does make a mistake, he or she needs to admit it, rather than conforming to a culture of secrecy and avoiding responsibility. After all, studies show that malpractice claims drop dramatically when a physician admits an error.

3. Hospital personnel should be encouraged to come forward when mistakes occur and create an open forum for acknowledgement without demanding some limited immunity to do so. Acknowledge the error and accept the responsibility.

4. Physicians need to be properly compensated by insurance companies. If doctors need to see 100 patients in an hour to reach their overhead – leading to short visits with each patient – there is less ability to provide adequate care for the patient. They need to be able to take the time to properly diagnosis and treat a patient.

5. Patients need to be protected against poor doctors. In New York, there are nearly 600 commercially uninsurable doctors currently practicing medicine – and putting patients at great risk. The medical community needs to identify and retrain these physicians. If that is not possible, then their licenses need to be revoked.

At the end of the day, the true medical malpractice “crisis” is the 98,000 deaths per year associated with avoidable medical errors. Physicians, hospitals, and other medical providers need to repair the dangerous system protecting negligent physicians to the detriment of their patients. After all, the goal is not-and should not- be to make it more affordable to harm patients. Rather, the medical community must begin to understand where errors originate so it can address the causes and empower patients to avoid them.