Defensive medicine is aggressive

The WSJ’s physician-columnist takes on the controversial topic today (via the WSJ Health Blog). He rightly estimates that 10 percent of medical waste can be attributed to defensive medicine. A more concrete number is $210 billion annually, from a PricewaterhouseCoopers analysis released earlier this year.

He writes that defensive medicine is also aggressive medicine:

It transcends being cautious or careful for the patient’s sake. It has everything to due with protecting the practice from the legal system. I try not to order expensive or risky tests to chase down minor lab or X-ray findings.

Some physicians feel compelled to do this. One thing that we doctors hate almost as much as a faulty diagnosis is winding up in court to defend our decisions. Once a doctor has had his judgment questioned in a lawsuit, his documentation and test ordering will never be the same. A typical line of legal attack is that you didn’t order a test or refer a patient to a specialist fast enough.

Via the internet, patients can sometimes play a role in test ordering patterns:

Patients are defensive, too. They look up their symptoms on the Internet and then insist on testing and consultations for symptoms that can be safely observed and frequently go away on their own.

What to do? Open up the lines of communication. Explain the risks and benefits of any test, as well as discuss the implications of not performing the study. That way, the patient can go forward with their eyes open.

Here’s my take on the subject in a USA Today op-ed.

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