A fascinating story of defensive medicine: How doctors feared treating a DA, and let the threat of a lawsuit cloud their medical judgement
“Looking back, I realize that practicing defensive medicine has become an unfortunate reality for every physician. But I’m convinced that ordering additional workups for Helen would have been expensive, unnecessary, and not helpful. She had already been bounced from doctor to doctor without much benefit.”

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  • Greg P

    One of the things I especially notice now that I’ve been in practice for 20+yrs when I observe housestaff or those just out of their residencies, is the folly of youth to think that medicine is about being the quickest to the “right” diagnosis, as if each patient is a question on a board exam.

    Defensive medicine or not, you can count on being wrong a lot of the time whenever you’re in a hurry.

    As a neurologist, a large number of patients I see are those who have already been to many physicians, maybe even several neurologists. Obviously, if the situation was cut and dried, the patient wouldn’t be sitting in front of me. So the overriding question tends to be, “How can I help this person?”, which in part relates to understanding why they keep going from doctor to doctor, when everything comes out negative (or maybe positive for something they don’t want to hear). For me to “defensively” order more tests as a matter of course is only going to add to this person’s anxiety. You need to get in their head, which takes time.

    And when you can help someone like this in any significant way, it’s very rewarding.

  • Curious JD

    There may not be a bigger canard in this debate than “defensive medicine”. It’s unquantifiable, so there is no telling if it helps, hurts, or changes things at all. It’s simply what the doctor says it is.

    What constitutes “defensive medicine” is solely in the mind of the doctor, nothing more. What constitutes it today may not constitute it post “tort reform”. A doctor can simply say after it is passed that X procedure is necessary and who can refute him?

  • Anonymous

    CJD,
    Take 4 years of medical school and 3 years of residency and you too will have a better idea of what a “necessary” test is.

  • jb

    The real victim of defensive medicine in this sad story is the patient, Ms. Carter.She was overtested, overmedicated, overcharged, and underserved. There is no question that somewhere towards the end of her million dollar workup at the University Hospital, one of her docs said, at least to herself, “There’s nothing physically wrong with this lady; she has a loose screw somewhere but there is no way that the medical profession can fix her.” So why did not anyone tell her this and give her (and her enabling lunatic mother) a gentle shove towards the mental health clinic that may have been her only salvation? Fear of getting sued. Fear of Ms. Carter being a one in a million case of whatever disease that didn’t show up on imperfect screening tests, of being called to the witness stand while her attorney accuses the doc of “just writing my client off as a nutcase, while she continued to suffer the ravages of myeloleukocytotic dystrophic malencephalopathy, Type IIIA.” It’s not worth it to any doctor to be wrong, to tell anyone after a thorough evaluation, especially a putative attorney, that it’s all in her head, when the alternative is to throw up your hands, tell her that you are out of ideas, and suggest that she may want to see another doc who can find something wrong with her. So, Ms. Carter suffers for a year, but her doctor does not have to worry so much. Dr. Porat is truly brave, but lives to tell us about his triumph only because he was right. The medicolegal system tolerates honest error poorly.

  • Anonymous

    To anon 3.52: Oh nonsense. Defensive medicine is undefinable–except, as you so wonderfully illustrate, by appeal to professional authority. Only the special initiates can understand it, according to your lights. Fine. But, if that’s the case, and you’re dealing with a term that cannot be reduced into verifiable/falsifiable claims, you’re not making scientific claims–and I’m not sure whether you’re opinion as to what defensive medicine is of any greater value than cjd’s.

    To jp: More nonsense. Honest error is not tolerated in modern capitalist economies. Executives cannot say they were honestly mistaken about sales forecasts so please don’t take away my bonuses. CEOs cannot say they were honestly mistaken about economic trends so therefore the B of Ds shouldn’t can them. Why are doctors different? The hatred doctors have of the law is that it holds them to a standard, and they apparently, like anon above, think they’re so special that what they do is beyond mortal evaluation.

  • Curious JD

    “The medicolegal system tolerates honest error poorly.”

    Really? Because you say so?