Defensive medicine
Defensive medicine is a practice where healthcare providers order unnecessary tests, procedures, or treatments primarily to protect themselves from potential lawsuits or to maintain their reputation. This phenomenon often arises from the fear of being sued for malpractice, particularly as malpractice claims have become more common since the mid-20th century. Physicians may also engage in defensive medicine under pressure from patients or their families who demand certain types of care, regardless of the appropriateness of such interventions. While defensive medicine aims to prevent legal repercussions, it can lead to increased healthcare costs and expose patients to unnecessary risks associated with additional tests or procedures.
Studies suggest that a significant portion of physicians—up to 75%—have practiced defensive medicine at some point in their careers. This practice contributes to rising healthcare expenses, with estimates indicating that billions of dollars annually are spent on these unnecessary medical actions. Some experts advocate for reforms in the legal system, proposing no-fault compensation mechanisms that could reduce the need for defensive practices while still providing support for patients who experience harm due to medical care. Understanding defensive medicine is crucial for navigating the complexities of the healthcare system and its associated costs.
On this Page
Subject Terms
Defensive medicine
Defensive medicine refers to any test, procedure, or treatment ordered by a physician that is not normally considered necessary for the patient's condition. Physicians usually do this because they are concerned about being sued or because they are worried about their reputation in some way. It might also happen because the patient insists on certain types of care, or because the patient's family pressures the physician to do everything possible for their loved one. Experts say that defensive medicine adds millions to the cost of health care and exposes patients to unnecessary tests and treatments. These tests and treatments themselves could pose extra risks to the patient.
Background
Physicians take an oath to act for the good of their patients, to use good judgment in treating patients, and to do no harm. This has been the standard for those in the medical profession for centuries, with penalties set for physicians who fail to uphold it dating back at least to 2030 BCE. There are instances of medical malpractice claims filed against physicians accused of not following standard medical procedures beginning in the nineteenth century in the United States. However, suing a physician because of a bad outcome for the patient was not a common occurrence until around the middle of the twentieth century.
Beginning in the 1960s, lawsuits filed by patients or their families who believed a physician provided substandard care began to increase. Patients who were dissatisfied with an outcome and those who suffered some form of harm would sue the physician in court to recover damages. Patients who could prove in some way that negligence on the part of the physician led to the injury or complication could recover financial damages. This negligence usually involves either an action by the physician (such as operating on the wrong limb) or an omission (such as failing to identify that a person with severe stomach pains has appendicitis). Over the last part of the twentieth century and early part of the twenty-first century, the trend toward suing physicians increased. As a result, experts say, many physicians have taken to practicing defensive medicine.
Overview
Defensive medicine can take several forms. Physicians can order extra tests or procedures to avoid missing a potential cause of the patient's condition or to confirm that what the physician thinks is the cause is correct. For example, a patient might come to the doctor with headaches. After talking to the patient and discovering that the headaches occur while the patient is at work at the computer for hours every day, the physician believes the patient is suffering from eyestrain and needs glasses. However, before sending the patient to the eye doctor, the physician orders a computerized tomography (CT) scan just in case the headaches are caused by something more serious, such as a tumor.
Another form of defensive medicine is when the physician avoids ordering or performing a procedure that could be risky even though the likelihood is that it will help the patient. If the physician does this out of fear of being sued or suffering some other personal consequence, it is considered defensive medicine. It could also be considered medical malpractice, depending on the outcome for the patient.
It is also considered defensive medicine when a physician orders any form of care solely because the patient or a family member is pressuring the physician to do so. A very common form of defensive medicine occurs when a physician orders an antibiotic for a child with a viral infection at the insistence of a parent. Viral infections do not respond to antibiotics, so the antibiotic will not help the child; it may, in fact, cause an infection when the antibiotic kills the child's helpful bacteria. However, physicians frequently prescribe an antibiotic simply to appease the parent.
Studies have shown that up to 75 percent of physicians admit to practicing defensive medicine at some point. While fear of being sued is a major reason given for the practice, it is not the only reason. Physicians can and nearly always do purchase medical malpractice insurance to cover the financial cost of being sued. Physicians may wish to avoid the time and difficulties involved in court actions related to suits. They may wish to protect their reputation from being associated with malpractice, even if it is unwarranted. They may see ordering extra tests and procedures as the new standard of care and be concerned that they will not look good in the eyes of their colleagues or patients if they do not order what other doctors are ordering. They may also bow to pressure from patients or family members, or they may simply be afraid of making a mistake and harming a patient inadvertently.
Studies have found that physicians whose patients incur the highest costs for tests and procedures do often have lower rates of malpractice suits. However, there is little indication that their patients have better outcomes. The studies also found that some physicians consistently order more tests than their colleagues even when they do not have patient populations with conditions that would require additional testing.
The prevalence of defensive medicine makes it a significant factor in health care costs. Since it is difficult to pin down exactly what percentages of health care procedures are done defensively, it can also be a challenge to find an exact cost for procedures, tests, and medications that are ordered defensively. Some estimates from 2015 place the cost of defensive medicine around $46 million. Others believe the figure could be much higher. Some organizations that study medical costs estimate that a quarter of all the health care dollars—a figure that reaches billions every year—are spent on defensive medicine.
This expense increases health care costs for everyone, since health care premiums are often based on the average cost to provide care for a given population. It also increases taxes to pay for the care of those on public care programs such as Medicare, Medicaid, and the Children's Health Insurance Program, also known as CHIP. Some experts recommend tort reform to fix this, eliminating the possibility of physicians being sued. Instead, patients who suffer harm as a result of medical care would be compensated under a no-fault system that would not require the physician to be deemed responsible for the injury.
Bibliography
Bakalar, Nicholas. "'Defensive Medicine' May Lower Malpractice Rates." New York Times,4 Nov. 2015, well.blogs.nytimes.com/2015/11/04/defensive-medicine-may-lower-malpractice-risks/. Accessed 12 Feb. 2018.
Bal, Sonny B. "An Introduction to Medical Malpractice in the United States." Clinical Orthopedics and Related Research, vol. 467, no. 2, Feb. 2009, pp. 339–47.
Gamble, Molly. "Top 10 Reasons Physicians Practice Defensive Medicine." Beckers Hospital Review, 5 Dec. 2012, www.beckershospitalreview.com/legal-regulatory-issues/top-10-reasons-physicians-practice-defensive-medicine.html. Accessed 12 Feb. 2018.
Oliver, Wayne. "Ending Defensive Medicine Is Key to Containing Health Care Costs." Investor's Business Daily, 24 Mar. 2017, www.investors.com/politics/commentary/ending-defensive-medicine-is-key-to-containing-health-care-costs/. Accessed 12 Feb. 2018.
Packer-Tursman, Judy. "The Defensive Medicine Balancing Act." Medical Economics,9 Jan. 2015, medicaleconomics.modernmedicine.com/medical-economics/news/defensive-medicine-balancing-act?page=full. Accessed 12 Feb. 2018.
Scherz, Hal, and Wayne Oliver. "Defensive Medicine: A Cure Worse than the Disease." Forbes, 27 Aug. 2013, www.forbes.com/sites/realspin/2013/08/27/defensive-medicine-a-cure-worse-than-the-disease/#6e826b637c95. Accessed 12 Feb. 2018.
Sekhar, M. Sonal, and N. Vyas. "Defensive Medicine: A Bane to Healthcare." Annals of Medical and Health Sciences Research, vol. 3, no. 2, Apr.–June 2013, pp. 295–96.
Torrey, Trisha. "Defensive Medicine." VeryWell Health,12 Jan. 2018, www.verywell.com/defensive-medicine-2615160. Accessed 12 Feb. 2018.