The fourth part of this continuing series. Defensive medicine isn’t all about ordering more tests. A reader writes about this recent telephone conversation:

Patient
I have a red eye for about 1 day and awoke with crusty discharge. My son has recently been diagnosed with conjunctivitis and is on antibacterial ointment.

Doctor
Any trauma to the eye, visual changes or light sensitivity?

Patient
No. Can you prescribe something over the phone?

Doctor
We have a strict policy where every patient has to be seen prior to prescribing medication.

Patient
That’s ridiculous. I’ve had bacterial conjunctivitis before, and my symptoms then were identical to this. Besides, you’ve prescribed antibiotics for me over the phone in the past.

Doctor
The symptoms certainly sound consistent with conjunctivitis, but without examination it is impossible to be certain. Unfortunately, the clinic is closed today, so you may have to go to the emergency room for evaluation.

Patient
What!? I’m NOT waiting 5 hours in the ER for a simple conjunctivitis. Why can’t you call something over the phone?

Doctor
Unfortunately, due to today’s liability climate, we have a strict policy of not treating patients over the phone – no matter how small the problem is. If you’re not comfortable with this policy, you are welcome to change practices.

Patient
Unbelievable! I think I may just do that. (hangs up)

I may have lost a patient, and drove up costs by advising a probable conjunctivitis to go to the ER, but at least there is zero possibility of being sued over this. It’s a trade I’ll make every time.

Defensive medicine is one of the leading factors in driving up health care costs today. The purpose of this series is to breathe some real-life examples into the numbers, and to provide some insight into how the threat of malpractice litigation pervades medical decision making.

Please e-mail me your stories of “how you practiced defensive medicine today”, and it will be posted anonymously as part of this continuing series.