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The Pitfalls of Defensive Medicine

Disclaimer: The views expressed are that of the individual author. All rights are reserved to the original authors of the materials consulted, which are identified in the footnotes below.


What is Defensive Medicine?


Defensive medicine is described as ‘the practice of doctors advising and undertaking the treatment which they think is legally safe even though they may believe that it is not the best for their patient’.[1] In simple terms, this refers to a doctor departing from normal medical practice to perform a treatment to avoid exposure to malpractice litigation.[2] Examples of defensive medicine include performing unnecessary diagnostic tests, prescribing excessive medicine and hospitalising patients needlessly.[3] Defensive medicine is highly controversial because it shows doctors prioritising their concern for his or her potential liability over a patient's welfare.[4]


Why do Doctors Practice Defensive Medicine?


Nearly three-quarters of doctors report practicing defensive medicine, with defensive medicine being estimated to cost the U.S. as much as $50 billion annually.[5]The key reason as to why doctors practice defensive medicine is to reduce chances of medical malpractice litigation.[6]For most doctors, especially those in high-risk specialties, there is a very salient risk of facing a medical malpractice lawsuit in the event that errors occur which would suggest that the doctor was negligent in his or her care.[7]Due to the prevalent perception that higher spending could signal to the courts that the doctor was exhaustive in his or her care, doctors are more likely to practice defensively even if they are aware that the additional procedures are unnecessary and offer no clinical benefits to the patient.[8]


Problems Caused by Defensive Medicine


i. Raises the cost of healthcare for patients


Due to the increased number of procedures, the cost of healthcare is increased for patients.[9]The unnecessary cost of defensive medicine is best demonstrated in a news article by US broadcaster CBS News, which reported that a patient had paid $8500 for a full CT scan and a radiation imaging scan, when she could have paid merely $1400 for an ultrasound.[10]The high costs of defensive medicine are problematic because this encourages the perception that healthcare is expensive, discouraging patients from seeing the doctor when they are in need of treatment.[11] Furthermore, the unnecessary costs that the hospital incurs from performing the additional procedures and scans could be put to better use in other areas of medical research.[12]


ii. Introduces distrust within the doctor-patient relationship


Considering that the doctor-patient relationship is built on trust and the obligation of the doctor to place the patient’s welfare above their personal interests,[13] the knowledge that the doctor is prescribing unnecessary treatments to the patient in an attempt to protect themselves from liability would greatly damage the doctor-patient relationship. [14]Distrust within the doctor-patient relationship could lead to adverse effects such as decreased patient compliance, self-medication, modification of medical recommendations and even the burnout of doctors after repeated failures of the patient to heed medical advice.[15]


Conclusion


Ultimately, defensive medicine is a huge problem that is damaging to both the patients and the healthcare profession due to the high costs incurred and the distrust introduced to the doctor-patient relationship. Although doctors may want to protect their interests, the root of the problem should be addressed by having healthcare reform to change the perception of doctors that a large amount of money and time has to be spent on treatment procedures to avoid medical malpractice claims. In doing so, this is likely to reduce the high healthcare costs brought about by defensive medicine and improve the doctor-patient relationship.


Juet Kweh Wee

Section Editor

Medical Law and Ethics


SOURCES


[1] Sidaway v Bethlem Royal Hospital Governors [1985] AC 871, 887 (Lord Scarman).

[2] Miraj Sekhar et al, ‘Defensive Medicine: A Bane to Healthcare’ (2013) 3(2) Annals of Medical and Health Sciences Research 295.

[3] Ibid.

[4] John Fanning, ‘Uneasy lies the neck that wears a stethoscope: some observations on defensive medicine’ (2008) 24(2) Professional Negligence 93.

[5] Jake Miller, ‘Does Defensive Medicine ‘Work’?’ (Harvard Medical School, 4 November 2015) <https://hms.harvard.edu/news/does-defensive-medicine-work-0> (last accessed 18 February 2020).

[6] Sekhar (n 2) 295.

[7] Miller (n 5).

[8] Ibid.

[9] Sekhar (n 2) 296.

[10] CBS News, ‘Defensive Medicine: Cautious or Costly?’ (22nd October 2007) <http://www.cbsnews.com/stories/2007/10/22/eveningnews/main3394654.shtml> (last accessed 25 February).

[11] Sekhar (n 2) 296.

[12] Ibid.

[13] Mark Wicclair, Conscientious Objection in Health Care: An Ethical Analysis (CUP 2011) 89.

[14] Sekhar (n 2) 295.

[15] Katarzyna Krot and João Pedro Sousa, ‘Factors Impacting on Patient Compliance with Medical Advice: Empirical Study’ (2017) 9(2) Engineering Management in Production and Services 73, 75.

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