Defensive Medicine
A recent investigation from the “Annals of Emergency Medicine” suggests that defensive medicine is being practiced more often than previously thought. Is this a bad thing and should it be changed?
So what is defensive medicine? Most professionals define it as the use of diagnostic tests and treatment measures primarily for the purpose of averting malpractice lawsuits. Although only a few physicians may admit that malpractice concerns are the reason for their decisions to admit a patient to the hospital or to order a specific test, data on triage and test ordering decisions in real life cases suggests that malpractice concerns are a much greater factor than physicians acknowledge.
Emergency Departments are a setting where defensive medicine is more likely to be practiced because emergency physicians are under considerable stress and must make decisions quickly. In addition, the ED is particularly susceptible to malpractice suits because there is limited opportunity for physicians to develop a relationship of any meaning with the patient or family. Other specialties in similar situations that may also practice defensive medicine is anesthesiology, radiology, and obstetrics.
Other recent studies include the June 1, 2005 JAMA article and the July 13 Annals article. These studies focused on a particular problem and looked at actual physician decisions. These studies support the fact that many patients are treated and admitted to hospitals for assurance reasons rather than actual clinical indications.
What these studies do not clarify is what the “standard of care” is for those particular areas. If attorneys can show that a physician deviated from the local "standard of care", then the physician can be held negligent. It really makes no difference if the literature supports your decision making. There are plenty of “hired guns” who are more than willing to testify that a physician deviated from the standard of care.
This study also went a step further and physicians were surveyed and categorized into high, medium, and low fear groups. In the analysis of patient records, the study determined that physicians with the greatest fear of malpractice were less likely to discharge low-risk patients compared with physicians with low malpractice fear. High-fear doctors were more likely to admit low-risk patients and to order additional tests compared to their colleagues.
Even though emergency physicians must see all patients regardless of how risky a patient’s case may be, the goal for each physician should be to make sure those patients are being treated appropriately and receiving the “necessary tests.” But what are necessary tests and who makes this decision. It is easy for third parties to look in retrospect and pass judgment. It is very different when you are on the front line dealing with the emotions of the families and patients along with the medical problem.
Focusing on mechanisms to improve patient safety at the hospital and institutional level as well as having physicians take an active role in this problem is a very important step. Nothing will happen with any significance until physicians can be assured that they are protected in some manner. Until then, the cost of defensive medicine will continue to rise.
So what is defensive medicine? Most professionals define it as the use of diagnostic tests and treatment measures primarily for the purpose of averting malpractice lawsuits. Although only a few physicians may admit that malpractice concerns are the reason for their decisions to admit a patient to the hospital or to order a specific test, data on triage and test ordering decisions in real life cases suggests that malpractice concerns are a much greater factor than physicians acknowledge.
Emergency Departments are a setting where defensive medicine is more likely to be practiced because emergency physicians are under considerable stress and must make decisions quickly. In addition, the ED is particularly susceptible to malpractice suits because there is limited opportunity for physicians to develop a relationship of any meaning with the patient or family. Other specialties in similar situations that may also practice defensive medicine is anesthesiology, radiology, and obstetrics.
Other recent studies include the June 1, 2005 JAMA article and the July 13 Annals article. These studies focused on a particular problem and looked at actual physician decisions. These studies support the fact that many patients are treated and admitted to hospitals for assurance reasons rather than actual clinical indications.
What these studies do not clarify is what the “standard of care” is for those particular areas. If attorneys can show that a physician deviated from the local "standard of care", then the physician can be held negligent. It really makes no difference if the literature supports your decision making. There are plenty of “hired guns” who are more than willing to testify that a physician deviated from the standard of care.
This study also went a step further and physicians were surveyed and categorized into high, medium, and low fear groups. In the analysis of patient records, the study determined that physicians with the greatest fear of malpractice were less likely to discharge low-risk patients compared with physicians with low malpractice fear. High-fear doctors were more likely to admit low-risk patients and to order additional tests compared to their colleagues.
Even though emergency physicians must see all patients regardless of how risky a patient’s case may be, the goal for each physician should be to make sure those patients are being treated appropriately and receiving the “necessary tests.” But what are necessary tests and who makes this decision. It is easy for third parties to look in retrospect and pass judgment. It is very different when you are on the front line dealing with the emotions of the families and patients along with the medical problem.
Focusing on mechanisms to improve patient safety at the hospital and institutional level as well as having physicians take an active role in this problem is a very important step. Nothing will happen with any significance until physicians can be assured that they are protected in some manner. Until then, the cost of defensive medicine will continue to rise.
posted by Anonymous at 6:15 AM
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