Defensive Medicine is a Symptom, Not The Disease

Glancing at the Unhealthy Corner of the Medical Practice System

Photo by humberto chavez on Unsplash

We are living through an increasingly litigious ecosphere. Patients expect better from their physicians, demand more from their administrations, and, most of all, rely extensively on their consumeristic predispositions. Consequently, governments raise the bar on quality and vigilance through indiscriminate clerical mandates and bureaucracy—the excessive dictates- which in turn places an extra burden on the medical community, predominantly physicians.

The concluding scenario stays a vicious circle of petition, mandate, and accountability. If the cycle is not corrected, it could cause the physician to burn out, change the profession, or take up a defensive medical practice. Whichever footpath a physician takes is not healthy for the medical.

Metaphorically speaking, altogether, the above three scenarios convey their own individual “can of worms.” Here within, I would like to discuss lone the topic of “Defensive Medicine.”

What is Defensive Medicine?

Defensive medicine refers to the type of medical practice preordained to avert the likelihood of pending malpractice litigations. Physicians taking up defensive medicine merely responds wanting to evade liability, in contrast, to benefiting patient. Latter may take in but not restricted to ordering tests, procedures, or scheduling multiple visits.

The practice of defensive medicine is one of the most undesired side effects of growing medical lawsuits. It raises healthcare costs and exposes patients to avoidable perils.

The defensive medicine practice remains not necessarily for the best benefit of the patient, even though it may seem to the patient as a positive move. A defending medical exercise simply aims to shield the practitioner against the patient who may be a potential plaintiff.

Types of Defensive Medicine

In general, defensive medicine can be categorized into two unique behavioral ways; “Assurance behavior” and “Avoidance behavior.”

Assurance behavior affects the ordering of additional yet redundant services for a variety of reasons. The said behavior is typically aimed to lessen unfavorable consequences, preventing patients from filing medical malpractice suits, or appropriate future legal action utilizing recording that the physician is practicing bestowing to the standard of care. On the other hand, avoidance behavior ensues when physicians decline to engage in high-risk measures or circumstances.

Rate of Defensive Medicine

The defensive medicine rate in the United States of America remains as high as 79% to 93%, predominantly in emergency medicine, obstetrics, and some other high-risk specialties.

Because the art of medicine encompasses an ocean of unpredictability, henceforth inescapably, every clinician in their particular lifetime has contemplated exercising defensive medicine in one form or another. The after-mentioned become even more manifest as the government’s role in healthcare delivery grows spacious, and patients have more access to information.

U.S. physicians are at the highest chance of being sued; hence overtreatment is expected in this country. The number of lawsuits against doctors in the United States has grown during the last decades, exerting considerable comportment on physician deeds and practice. The numeral of Physicians ordering excessive tests or dodge high-risk patient treatment to reduce exposure to grievances continues to increase. More than ever, Medical doctors bring an end to their practice because of exorbitant insurance premiums.

Possible causes of Defensive Medicine

Defensive medicine is a reaction to the intention to take legal actions and the rising costs of malpractice insurance premiums. Patients’ inclinations on litigating may be for deferred diagnosis or treatment but usually not for being over-diagnosed.

Even the Healthcare reform, including the Affordable Care Act (ACA), has failed to improve the efficiency of health care delivery by missing to recognize the powerful motivation that liability qualms hold on physician practices.
The medical malpractice system, often unkempt in the healthcare dialogue, is deceptively due to the credence by the collective that liability has more to do with inadequacies in physician-patient communication than it does with the overall level of expenditure elected by physicians. The end may hold some truth, but the emphasis, the disparity between the patient expectation, insurance carrier reimbursement practice, and tunnel vision of the legislatures is, in fact, a prominent source of insufficiency between physicians and patient communication.

Being sued may not be unswervingly about whether physician orders countless or few tests. Barring the multifacetedness of physicians' burden, it may force them to select the self-protective route as a shortcut remedy.

Indeed, bedside manner and how well doctors interact with patients can reduce malpractice litigation. However, the clinician who finds themselves on the verge of burnout while taking care of a strong-opinionated patient in the company of limited means will probably wield extra discretion to prevent legal action.

Interpersonal factors undoubtedly influence liability risk; still, the vast majority of U.S. physicians who practice defensive medicine is reminiscent of spending has a role to play in lessening liability risk, or at least that does in physicians' independent cognizance.

A study published by the British Medical Journal unveils that physicians with higher expenses in a given year were considerably less likely to be sued for malpractice. Midst obstetricians, for whom C-sections are often defensively inspired, state that doctors with higher C-section rates faced fewer law suites than their conservative counterparts.

Consequences of Defensive Medicine

Defensive medical practice and higher spending, accordingly, seem to reduce the likelihood of adverse outcomes. The higher disbursement may similarly prompt patients, judges, and juries; the doctor stayed exhaustive in their workup and treatment despite wrongdoing. In either setup, the ground for physicians to lessen healthcare spending is dramatically benumbed by the feasibility that their susceptibility to lawsuits may grow if they do so.

Defensive medicine is a prominent patron of the rise of healthcare costs in the United States. By estimation, defensive medicine adds $25.6 billion or 34% to already rising healthcare expenditure annually.

Overtreatment with antibiotics is a well-recognized mark of defensive medicine. It threatens everyone, as bacterial resistances such as Methicillin-resistant Staphylococcus aureus (MRSA) can develop, causing untreatable infections in countless patients. Or we may not practice appropriate medical treatments such as watch-and-wait for some low-risk, slow-growing prostate cancers because patients demand belligerent therapy options such as radical prostatectomy, radiation, or hormone therapy.

A study conducted by authors from Harvard University and the University of Melbourne estimated that defensive medicine cost Americans $45.6 billion annually in 2008 dollars, accounting for more than 80% of overall yearly incidentals of the medical liability practice.