Thursday, July 01, 2010

What Exactly Is "Defensive Medicine"

A medical resident writes of the rise of what he calls "defensive medicine" in medical practice,
Our predecessors were able to gather essential pieces of clinical data from a physical exam. Today, in the world of overburdened emergency departments, full hospitals, and electronic ordering and note-writing systems, we are forced to spend less and less time with our patients. In an attempt to compensate for this problem, we make up in quantity what we cannot provide in quality – and we make up with money what we cannot provide in time. Although the perception is that patients benefit, by getting a myriad of lab tests and imaging studies, they do not. These tests mean very little unless they are correlated clinically. They only become significant in the setting of the patient.

Rather than realizing this, clinicians have begun to practice test-centered medicine rather than patient-centered medicine. This causes huge delays and expenses in patient care. It also places patient at risk for (1) being treated unnecessarily for incidental findings and (2) being exposed to unnecessary radiation. Furthermore, it alienates patients even further from their physicians – and this, perhaps, is the greatest cause of increased lawsuits and patient dissatisfaction, which starts the cycle of practicing defensive medicine all over again.
The conceit behind "defensive medicine" is that fear of lawyers and litigation compels some doctors to perform unnecessary tests and procedures in order to cover themselves if they misdiagnose a patient. The argument that such a form of "defensive medicine" exists is weak. But if the real problem is that doctors are too rushed, harried and/or unpracticed to take a complete history and perform an effective physical examination, and are using tests as a substitute, that's not something that can be blamed on lawyers.


  1. "Defensive medicine" sounds a lot better than "Every time I order a test for a patient, I can bill for it." Particularly for doctors with a financial stake in the testing facility.