Some lawyers say defensive medicine isn’t real, but this doctor shows us otherwise

January 23, 2009

Lawyers and left-leaning policy wonks often discount how pervasive defensive medicine is.

WhiteCoat, an emergency physician, is almost convinced by those who call defensive medicine a figment of the medical profession’s imagination.

Then he starts his shift working in the emergency department, an experience that most lawyers and policy experts do not have by the way, and cites specific examples where he made a decision specifically to thwart potential exposure to a malpractice lawsuit.

Many of these decisions did not benefit the patient, but satisfied society’s expectation that doctors be perfect. “Clinical medical judgment has been supplanted by the demand that physicians disprove the improbable,” writes WhiteCoat. “Many physicians are afraid to practice rational medicine based upon clinical judgment and physical examination skills. No one wants to face the liability.”

So help the good doctor out. If physicians aren’t expected to be perfect, “which ‘bad outcomes’ are ok to miss in the absence of exhaustive diagnostic testing?”

I’d like to know myself.

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Tagged as: emergency, malpractice, patient

{ 9 comments }

1 Throckmorton January 23, 2009 at 7:57 am: We just did a review of the CT angiograms that were done in our emergency department. There were 456 in the study period. There was one positive.

We are trying to get the data on the head cts but the numbers are staggering.
2 Anonymous January 23, 2009 at 10:21 am: It may be real, it’s just undefinable at this point. You can say “tests done to avoid liability”, but you don’t know if the tests you’re performing actually DO reduce liability. Nor have you offset any increased costs with the gains from the test discovering something that you DID miss.

The term “defensive medicine” remains nothing more than a politicized phrase meaning nothing.
3 Rogue Medic January 23, 2009 at 11:13 am: It is about time people started listening to Dr. White Coat. He makes a lot of excellent points about the damage done by defensive medicine.
4 Rogue Medic January 23, 2009 at 1:55 pm: Anonymous,

Maybe the term is a meaningless politicized phrase, but the practice is not insubstantial or meaningless.
5 Anonymous January 23, 2009 at 4:57 pm: Rather than eliminate tort law (which is really what this is all about), wouldn’t it make sense to give ED a quota of CTs, a number perhaps derived from careful epidemiological study, and then make doctors pay some sort of fee (or pay reduction) for tests that exceed their monthly CT quota.
6 Anonymous January 23, 2009 at 7:25 pm: The practice is neither insubstantial or meaningless, it’s undefinable.
7 Anonymous January 24, 2009 at 8:26 am: Who’s paying for unnecessary tests (or more importantly, who’s profiting from them)? If there’s any monetary incentive for clinics and hospitals to order them, it’s not just about defensive medicine.
8 Anonymous January 24, 2009 at 7:20 pm: I can’t weigh in on which ‘bad outcomes’ are ok.

But – Why is it reasonable for patients to hold all physicians to godlike standards? (Yes, there are people who don’t know what they’re doing – but that is true for all jobs/professions.)
Undesired outcomes don’t necessarilymean the physician has done something wrong or exacerbated the situation – in spite of best efforts, the circumstances were such that they could not be overcome. Pts are not perfect, either – how many times does a dr see a pt who is the ‘textbook example’? What about the pt who is in the wrong place at the wrong time, desperately in need of facilities and expertise that is not where they happen to be?

Maybe we pts need a few strong doses of reality/common sense and decreased intake of televised medical faux-heroics.

My mother passed away a number of years ago – many years of smoking messed up her lungs to the point where a stable airway could not be reestablished. I miss my mom to this day, but I have nothing but deep respect for all of the medical professionals who did their best working that code. What I hope is that the experience helped further the knowledge, skill, and understanding of those who had not previously treated a pt with false airways.
9 Rural PCP September 22, 2009 at 6:20 pm: Defensive medicine is live and well. I have insurance companies and workmans compensation carrier that in fact call and request pricey tests like MRI’s and CT’s on a regular basis. They send patients to the ER after MVC’s even if the patient has no injuries or complaints. You have to do all the x-rays, CT’s, and MRI’s because some may come back and sue in the future for “pain and suffering” (totally subjective and unmeasurable claim).They are covering their backs as well. Does this increase medical care costs as well? Yes. The rising costs of medicine in the United States is a societal problem at its basis. The public demands the highest standards of care with instant cures and absolutely no errors what so ever. Physicians are looked to as “gods” because they are felt to be infallible and omniscient. If they fail to be so then the public sues. The physician is sent the message that they are an absolutely awful physician and if they don’t quit practicing medicine they get more and more tests to make attempt the next time to not miss anything and have to go through the legal minefield again. The unfortunate standard of care has become absolutely accurate diagnoses and cures all the time with absolutely no side effects. This is not humanely obtainable. Physicians like everyone else are human and subject to human error. They have bad days and miss things. Unfortunately the public expects physicians to see patients at all hours of the day every day of the year, even if the doctor has not slept in 24 hours, and all they do be completely infallible. All patients must live forever even if the patient has not taken the best care of their health all their lives or are extremely elderly (90 years old plus). There is also many of our populace out there who would love to have a physician, or anyone else, have a human error so they can sue for a large “settlement” and retire to the lap of luxury without the need to ever work again. The government seems to be all to happy to support this by giving out government assistance and free money to any and all lazy individuals. Yes there are some that are justifiably disabled but I have seen all to many who are fifth and sixth generation welfare and people on disability that “get stressed going to work” or “can’t get along with others” so are on disability. We need to fix the societal problem and maybe many will not seek lawyers and CYA medicine will decrease.