Posted by Bill Sandweg on 02 December 2019.
Defensive medicine is the name given to actions taken by doctors, not for the primary benefit of their patients, but to reduce the chance they will be sued for medical malpractice. It is unethical and almost always detrimental to the patient.
The Hippocratic Oath originated in ancient Greece. Modern versions of it are still used by today’s doctors. One of its main tenets, subscribed to by all, is that the doctor will not put his or her interests ahead of those of the patient. To do otherwise is to act unethically but that is exactly what defensive medicine does and many doctors admit they practice it.
Defensive medicine arises out of what doctors who practice it claim is a legitimate fear of being sued. This is a fear they have largely manufactured for themselves. They have been drinking their own Kool-Aid.
For many years, doctors, hospitals and their insurance companies have been trying to get laws passed to give themselves special benefits not available to you or me. They want laws that prevent or limit suits against them when they make mistakes and injure patients. To justify this special treatment, they claim that they are special and deserving of special treatment. They also claim, however, that they are the victims of a flood of frivolous lawsuits. This is the Kool-Aid they sell to gullible state and national legislators.
It is not true that doctors are subject to a barrage of frivolous lawsuits. Very few doctors ever get sued. When they do get sued, juries are very protective of them. Doctors win about 85% of all cases that go to trial throughout the United States. Furthermore, the number of medical malpractice claims has been dropping for years. Despite the increase in the population in the United States over the last 30 years, the number of paid malpractice claims has been declining over that time. Today the annual number of paid malpractice claims is just over half of what is was in 1990. There is no tsunami of malpractice cases and, when sued, doctors do very, very well in the courtroom. They don’t need to act unethically to avoid being successfully sued.
Defensive medicine takes two forms. In the first, the doctor orders tests the doctor does not believe the patient needs. He or she says they order these tests so, if things go badly, no one will be able to accuse them of not ordering all possible tests. Unnecessary testing is bad for patients. In the first place, some tests are dangerous or at least pose risks to patients. X-rays expose patients to radiation. Blood tests have a risk of infection. All tests have what are called “false positives,” which are positive results even when the patient does not have the condition being tested for. False positives usually result in even more testing or in actual treatment for a condition the patient does not have. In the second place, someone has to pay for these unnecessary tests. Depending on the patient’s insurance status, that may be an insurance company or the patient or some combination of the two of them. Regardless of who pays, this is health care money that should have gone to necessary testing and treatment and not be wasted protecting the doctor.
The second form of defensive medicine is more harmful to patients than the first. In the second form, doctors avoid patients with complicated or advanced diseases so they won’t get sued if the patient dies or does not do well. I have seen this often in my practice. When a patient has been the victim of malpractice but needs additional treatment, it can be very difficult to find a doctor who will be willing to treat the patient. They see the malpractice and can see the likelihood of a suit and don’t want any part of the care of the patient. Some of my clients have had to go out of state to get necessary treatment because no Arizona doctor would touch them.
Patients deserve doctors who think of the patient first and themselves second. When you go to the doctor, say a prayer that you get an ethical doctor who places the interests of the patient first.