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Stephanie Nano, AP

A substantial number of heart doctors — about one in four — say they order medical tests that might not be needed out of fear of getting sued, according to a new study. Nearly 600 doctors were surveyed for the study to determine how aggressively they treat their patients and whether non-medical issues have influenced their decisions to order invasive heart tests.

Most said they weren't swayed by such things as financial gain or a patient's expectations, but about 24 percent said they had recommended tests because they were worried about malpractice lawsuits. Doctors who treated their patients aggressively were more likely to be influenced by malpractice worries or peer pressure than those who weren't as aggressive, the study determined.

The research was done to see whether doctors' attitudes and practices might be contributing to the wide differences in health care use and spending across the country.

“We have known for a long time that where you live has an influence on what kind of health care you get and how much health care you get,” said Lee Lucas, lead author of the study and associate director of the Center for Outcomes Research and Evaluation at Maine Medical Center in Portland.

Medical malpractice was part of the health care reform debate, but didn't make it into the recently approved legislation. The new law does include pilot programs for states to explore alternatives to lawsuits. The study was released Tuesday by the journal Circulation: Cardiovascular Quality and Outcomes.

The results support moving toward more integrated health care, and away from fee-for-service payments, and working on malpractice reforms, said Kenneth Thorpe, a professor of health policy at Emory University in Atlanta.

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