Kevin MD has a classic post – More ATLA: “Defensive medicine is a hoax”

Please read his column and (if you can handle it) the comments.

Here are my thoughts on defensive medicine. First, physicians and lawyers probably cannot have a constructive discussion on this point because we do not share a common understanding of vocabulary. Part of professional school is learning the vocabulary.

As I consider defensive medicine, what I see (and admittedly I cannot quote a study) is testing prior to a careful history and physical. Why? Because one can always defend a test result, and the history and physical are not considered as definitive. Most patients who come through an Emergency Room in 2006 have a CT scan (I am being a bit hyperbolic here, but not overly hyperbolic). Ask any radiologist, internist or family physician about the number of unnecessary CT scans in ERs and they will all tell stories.

Another example from an ongoing research study. No evidence currently exists for obtaining both an MRI and a CT of the head for routine strokes. Either will find a bleed. Yet an increasingly high percentage of stroke patients have both expensive tests.

We physicians worry more about missed diagnoses than the consequences of false positive testing. Yet I believe (again I admit that this is an opinion) that more money is spent and possible harm done from false positive tests.

Quantifying defensive medicine seems a most challenging methodologic issue. Perhaps there are studies out there – fortunately I have smart readers and hopefully someone has the right references. But I cannot believe that the ATLA would deny the phenomenon of defensive medicine. But then some lawyers would argue that my dog is really a cat. And some lawyers might convince a jury.