Defensive medicine is aptly named. The term implies both actions to prevent
litigation and an untrusting attitude toward patients. Defensive medicine is
based on three assumptions: that making more accurate diagnoses will reduce
malpractice claims; that tests and procedures improve the probability of a
correct diagnosis; and that the use of more technology implies better medical
care. [Harris JE. Defensive medicine: it costs, but does it work?
1987;257:2801–2802.] These assumptions come from a physician-oriented
view of medical care. The problem is that patients, not physicians, bring
malpractice lawsuits. Patients are primarily concerned with the outcome and
the humanistic aspects of their treatment. It is physicians who care about
diagnoses. Patients want to be treated well and successfully. Defensive
medicine generates anger and expense, both of which increase the probability
that an injured patient will seek legal counsel.
Defensive medicine directly increases the probability of injury when it involves
dangerous tests or procedures. For example, intravenous pyelograms (IVPs)
pose a significant risk of complications. If an IVP is ordered as a necessary
diagnostic test, the risk of the procedure is balanced by the benefit of the
diagnostic information that it produces. If an IVP is ordered as a defensive
measure, there is no benefit to the patient to offset the risk. Since a defensive
test or procedure is, by definition, one that does not have a favorable risk or
cost benefit ratio for the patient, the patient may be expected to sue
successfully for any major complications of a defensive test or procedure.