This debate is all about how the issue is framed. The opponents of health care insurance reform are using this as a chance to limit lawsuits. Maybe instead of talking about “defensive medicine” the proper label for this cost in our health care system is the cost of medical certainty. We should re-focus our debate on how much we as a society are willing to pay for proper and timely diagnosis – using the technology available to us in the US – rather than trying to make those already hurt by medical negligence bear the further cost of not having an adequate remedy in court.

1. It is easier and faster to do the test, give the treatment,etc., and so it therefore represented the simple road, especially if the patient isn’t paying. So they chose the easy road, and have developed defensive medicine arguments in part as a justification for that.

2. I can’t tell you how often I heard physicains reject any effort to establish guidelines, pathways, or any other incorporation of clinical effectiveness research. It was “cookbook medicine” or some such and therefore represented an intrusion into their freedom to practice. And they were afraid, for reasons I will never understand, that the protocols would work against them. When I explained that evidence-based protocols, when followed, could only help justify their choices, they refused to hear my words. I believe they wanted to be free to do whatever they wanted without having to justify any deviance from the evidence-based practice.

I wonder how different our scene might be today had the medical community embraced clinical effectiveness as the primary standard of practice twenty years ago? And viewed it as their best defense against malpractice?

Of what professions are the critics, I wonder, who criticize the doctors, nurses, soldiers, police,firefighters…