Saturday, May 5, 2012

The myth of defensive medicine: Part I

It's been a truism of the last four years of medical school- when in doubt, order some more tests so that you'll have more ammo in court when this patient sues you, commonly expressed: "sues your ass." Politely termed "defensive medicine," it's known on the floors as CYA, "covering your ass." It's no coincidence that this crass thinking is supported with crass dialog.

Doctors who are so keen to avoid lawsuits would probably be very interested to read this Archives of Internal Medicine commentary, which states:

"Ironically, some of these protective steps, far from reducing legal risk, may actually increase it."
This research is not at all new--it's been known since the 1990's that not all patients with even a bona-fide gripe sue, and that the primary reason for lawsuits is poor communication. A vast amount of research boils down to a simple point:
Listen more, get sued less.
But how many times on rounds have I been privy to a discussion where the attending physician justifies another CAT scan by saying:
"We have to cover our asses here: let's order a CAT scan."
If these physicians were so concerned about litigation, their warning should have gone:
"We have to cover our asses here: let's get in there and talk to this patient, share our uncertainties honestly, and listen to their concerns."

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