Some Thoughts on Defensive Medicine

Patient Getting an X-rayDr. Pauline Chen recently wrote a piece from her perspective as a physician about why doctors order so many tests.

She mentions three reasons why physicians typically order extra tests for a patient:
1. Fear of med mal liability exposure. Although physicians have professional liability insurance, no one wants to use it. This is classic defensive medicine.
2. Lack of adequate time for patient visits. Lack of time leads physicians to order more tests and/or refer to specialists.
3. Clinical guidelines. Though intended to streamline care, many physicians feel that they have had the opposite effect.

Interestingly, though, the reason Dr. Chen gave in her own scenario was that it would have been faster to offer the unnecessary care. It would have been faster to give unnecessary care than to explain to her elderly patient why the extra care was not needed. I have heard the 3 reasons mentioned above many times before, but this one was a new one to me. Considering that doing extra tests could conceivably save Dr. Chen from liability exposure and that it would keep her day on schedule and make the patient happy, it becomes harder and harder to not order those tests. The issue of defensive medicine is a tough one and it gets tougher the more I hear about it.

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