The findings were based on surveys of 33 emergency doctors who participated in a prospective study of 1,134 patients at two teaching hospitals.

Given the vast number of patients involved, these findings have implications for understanding how the practice of "defensive medicine" may increase the cost of health care, said the study's lead investigator, David Katz, M.D., associate professor of internal medicine in the UI Roy J. and Lucille A. Carver College of Medicine.

"The fear of malpractice accounts for a significant portion of the variability in what doctors do in the emergency room," said Katz.

Through a survey of the emergency physicians, the researchers used a "malpractice fear scale" to rank the doctors into high-, medium- and low-fear groups. Then, by analysing patient records, the team determined that physicians with the greatest fear of malpractice were less likely to discharge low-risk patients compared with physicians with low malpractice fear. Instead, these high-fear doctors were more likely to admit low-risk patients and to order chest X-rays and troponin tests, which can measure heart damage.

"In isolation, plain chest X-rays at $150 and troponin at $44 are relatively inexpensive health care costs, but the volume of patients getting them really raises the overall price tag," Katz said. "However, the greatest cost is the cost of admission, which can be as high as $1,200 per patient for a brief hospitalisation.

"Emergency physicians must see all patients, regardless of how risky a patient's case may be. One way physicians may respond to this is by seeking consultations and admitting patients they are uncertain about," Katz added.; Source: University of Iowa