The OTA concluded that no more than 8% of diagnostic testing is “consciously defensive.” 3 This misses the larger point, however. The OTA acknowledged “there is simply no acceptable method for measuring the full extent and national use of defensive medicine.” 3 Faced with the problem, they surveyed physicians about hypothetical clinical scenarios designed to raise issues of potential malpractice liability. Who defines “ideal medical practice”-physicians, patients, the courts, or society at large? There is no “gold standard” against which defensive medicine can be compared. Though this definition makes clear that defensive medicine is undesirable, the costs remain difficult to measure. The Office of Technology Assessment (OTA) approaches defensive medicine in a manner that is somewhat closer to clinical reality: “when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures primarily (but not necessarily solely) to reduce their exposure to malpractice liability.” The basis of the choice need not be conscious and the practice is not necessarily without benefit to the patient. Virtually all medical tests and procedures offer at least some possible benefit to the patient. However, this definition is not particularly close to the way doctors approach most clinical problems. ![]() This violates the Hippocratic Oath, does violence to the doctor-patient relationship, and is manifestly self-serving for the physician. Definitionĭefensive medicine can be simply defined as medical responses undertaken to avoid liability rather than to benefit the patient. Then I will assess the costs of defensive medicine and examine how the practice can be widespread, yet often go unrecognized. Not until then will we be able to do something about it.įirst, I will explore the meaning of defensive medicine and why it has become so prevalent. Others believe this to be quite untrue and find the concept “morally unconscionable” 1 and “reprehensible.” 2 Precisely because the concept is elusive and the practice is pervasive, it is incumbent upon us to define the process and understand its effects. Some of us know it, acknowledge it, and accept it. ![]() Physicians practice defensive medicine all the time. The Medical Liability Insurance Landscape ![]() What Are MICRA's Most Effective Provisions? Medical Malpractice Alternative Dispute Resolution Systems: Can They Work? How Should Physicians Handle Patients Requesting Unnecessary Tests?īMJ Study: Physician Spending and Subsequent Risk of Malpractice Claims Defining "Defensive Medicine" and Why It's a Violation of the Doctor/Patient Relationship
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