Defensive medicine


Defensive medicine

Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily not to ensure the health of the patient, but as a safeguard against possible malpractice liability.[1] Fear of litigation has been cited[2] as the driving force behind defensive medicine. Defensive medicine is especially common in the United States of America, with rates as high as 79%[3] to 93%[4], particularly in emergency medicine, obstetrics, and other high-risk specialties.

Defensive medicine takes two main forms: assurance behavior and avoidance behavior. Assurance behavior involves the charging of additional, unnecessary services in order to a) reduce adverse outcomes, b) deter patients from filing medical malpractice claims, or c) provide documented evidence that the practitioner is practicing according to the standard of care, so that if, in the future, legal action is initiated, liability can be pre-empted. Avoidance behavior occurs when providers refuse to participate in high risk procedures or circumstances.[4]

Theoretical arguments based on utilitarianism conclude that defensive medicine is, on average, harmful to patients.[5]

References

  1. ^ Anderson RE (November 1999). "Billions for defense: the pervasive nature of defensive medicine". Arch. Intern. Med. 159 (20): 2399–402. PMID 10665887. 
  2. ^ http://society.guardian.co.uk/health/comment/0,7894,1450447,00.html
  3. ^ http://www.aaos.org/news/bulletin/janfeb07/clinical2.asp
  4. ^ a b Studdert DM, Mello MM, Sage WM, et al. (June 2005). "Defensive medicine among high-risk specialist physicians in a volatile malpractice environment". JAMA 293 (21): 2609–17. doi:10.1001/jama.293.21.2609. PMID 15928282. http://jama.ama-assn.org/cgi/content/abstract/293/21/2609. 
  5. ^ DeKay ML, Asch DA. Is the defensive use of diagnostic tests good for patients, or bad? Med Decis Making. 1998;18:19-28.

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