Defensive Medicine and Medical Malpractice

Defensive medicine is the practice of medicine in such a manner as to minimize the likelihood of the physician being sued. This has several components. First, and most costly, is the ordering of tests to look for serious, but unlikely, conditions. For example, a brain tumor may cause headaches, but most headaches are not caused by brain tumors. In dealing with a patient presenting with headaches, good medicine involves taking a careful history, performing a neurological examination, and only ordering costly neuroimaging procedures if there are additional suggestive symptoms or signs. A practitioner of defensive medicine would order a scan on every patient with headaches, for fear of missing a tumor and being sued. Unfortunately, due to fear of litigation the distinction between good medicine and defensive medicine has been blurred, and defensive medicine practices are seldom recognized for what they are.

Second is the use of precautionary hospitalization when it is not likely necessary. When a middle-aged overweight hypertensive sedentary male smoker comes to the emergency room with chest pain, one may be justified in admitting him to rule out a heart attack. On the other hand, when a young thin healthy woman with previous history of anxiety attacks comes to the ER with chest pain, it is unlikely she needs the same diagnostic/therapeutic approach, but she may receive it anyway.

Third is the avoidance of high-risk situations by physicians. Many qualified specialists have stopped taking emergency room call, doing hospital work, and treating patients with complex medical problems.

Medical malpractice is the occurrence of an adverse event directly resulting from a patient’s failure to be provided proper medical care. This is often litigated, with competing experts giving different views of by what standard proper medical care should be judged.

When a patient suffers an adverse outcome of medical treatment, it is far more likely due to bad luck than to improper care. He/she is less concerned with whose fault it is than with having the situation made right. The money spent on litigation and on excessive judgments in our present system could be used more effectively to help more patients who suffer adverse outcomes.

Therefore, as part of the health care reform scheme outlined herein, the tort system for medical malpractice would be replaced with a no-fault system. Patients suffering adverse events related to health care would have any extra care required because of this automatically covered by the plan. If improper care was alleged to have caused death or disability, independent panels of experts and patient representatives would review the claim and award compensation if appropriate. The panels would also recommend modifications in care protocols if deficiencies were found. Providers who practice good medicine would not have to worry about ordering unnecessary tests and treatments, and the costs saved by these not being performed, and by avoiding litigation, could be used to compensate patients who are truly harmed by improper care.