We often think of it as “unnecessary tests done in fear of litigation” – but, of course, litigation rarely results from the failure to order a test, it results from the whatever sequellea result from not treating what would have been revealed by the test if it had been performed. If this is so, then the tests that are the product of “defensive medicine” are not medically unnecessary – they are, in the stereotypical case at least, a sginificant contribution to patient care, by allowing treatment of conditions that would otherwise have gone overlooked (and result in litigation).

So what is wrong with “defensive medicine”? Mostly that it results in many tests that do not signal a diagnosis that would have been missed otherwise – and thus do not contribute to care, while running up costs and demand for services.

Here is an interesting question: what is the difference between practicing “defensive” and “non-defensive” medicine? The “defensive” doctor, again in the stereotype case, orders any test that could conceivably be relevant at the drop of the hat – presumably uncovering a larger percentage of those subtle conditions that would otherwise be misdiagnosed, but at great cost and a highly inefficient use of resources. The non-defensive doctor works systematically through the differential diagnosis, ordering only those tests that seem likely to provide the crucial confirmatory/disconfirmatory evidence among possible diagnoses on the list – and presumably, thereby, missing a larger fraction of “bizarre” cases and subjecting patients to longer waits (while working down to the very unlikely portion of the differential diagnosis list), but keeping costs as low as possible and utilizing resources as efficiently as possible.

What is good or bad about either? Obviously, “defensive” medicine is aggressive and, one hopes, more likely to explore and expose every potentiality, though wildly inefficient and highly expensive. “Non-defensive” medicine is methodical, intelligent, and efficient, but requires the patient with an obscure or unlikely presentation to wait longer, suffer longer, and run a higher risk of misdiagnosis.

Which is better? It depends on the relative values we assign to affordability, patient suffering, speed, accuracy, and efficiency.

Why is “defensive medicine” now (seemingly) so common? We have incentivized test-orderers (doctors) to be highly sensitive to the costs of missed diagnoses, and only secondarily to the costs of . . . well, costs.

Why was “defensive medicine” not common previously? Doctors are not trained to practice scatter-shot diagnosis – they are trained to use medical knowledge and science to work through the case presentation intelligently and responsively. Bill-payers (especially third-party) were incentivized primarily to keep costs down, only secondarily (if at all, in the case of third-party payers) to minimize patient discomfort.

What are the consequences of the shift to defensive medicine? It’s costly, but may improve the likelihood and speed of arriving at a correct diagnosis, particularly in the case of obscure or atypical presentations. This doesn’t actually seem like a bad thing, though we demonize doctors for it.

After all, if the medical test is medically necessary, it is proper treatment and not “defensive medicine.”

Did you even READ his post. He agreed that the Doc should have done the ultrasound and was thereby defending “defensive medicine.” Your kneejerk response to interpret everything doctors say about other doctors as “covering up” is pathetic.

BladeDoc

If one were to post an article about a physician operating on the wrong body part, though, you’d hear a chorus of – “Well, you can’t tell everything from the newspaper. There’s probably much more to the story. Newspapers never report medical stories correctly!”

At least you are consistent with the defensive medicine cry. Of course, in this “litigious environment”, the doc still didn’t order the ultrasound. Hmmm, that seems to cut against your theory that the present climate results in wasteful testing.