Defensive Medicine Should Protect YOU,
Not Your Doctors
Defensive medicine is the term used to describe physician practices intended to protect them from medical malpractice lawsuits. Examples include ordering CT scans and other diagnostic tests that are often unnecessary, as well as invasive procedures and hospitalizations that may put their patients in harm’s way.
One of the failings of Obamacare is that it doesn’t meaningfully address the medical malpractice crisis in America, especially the defensive medicine practices that drive so much of our healthcare spending and medical injuries (see “Obamacare 2.0 – Fixing Medical Malpractice“).
And what exactly is the medical malpractice crisis? Is it malpractice premiums soaring out of control in our overly-litigious culture that forces doctors to practice defensive medicine that compromises their patients’ safety, as many of them still contend?
Not so much. Medical malpractice claims in America have been setting record lows for several years now. And with some exceptions, medical malpractice premiums have declined by up to 5% a year for the past several years. This article in The New England Journal of Medicine explores why the fear of medical malpractice claims continues to drive defensive medicine practices despite a general tempering of medical malpractice claims and awards.
In this unfortunate but prevailing context of medical indifference to the treatment risks and medical errors associated with these defensive medicine practices, there’s no viable alternative for thinking consumers but to think defensively themselves when it comes to their recommended medical treatments.
This means considering the risks of treatment as seriously as you consider the risks of any disease you’re diagnosed as having or for which you’re at elevated risk.
Understanding and managing your treatment risks, including diagnostic tests and procedures like CT scans and biopsies, is as integral to staying healthy or restoring your health as understanding your disease risks.
This means never consenting to a test or procedure without first asking about and fully understanding the risks of a negative effect from the test or procedure. This should then be compared with the known risks and benefits of any alternative tests and procedures that yield similar results.
Considering the evidence of broad-based incompetence and indifference to patient safety discussed in Our Healthcare Sucks, the prudent consumer fears the possible consequences of medical interventions as much as the suspected disease itself. And the prevalence of defensive medicine – admitted to by 94% of doctors surveyed – makes the logic for such caution all the more compelling.
Learn to Apply Your Own Brand of
Much of how American physicians practice medicine – high-tech “solutions” for low-tech problems – is understandable given their training in high-tech academic medical centers, their fear of lawsuits and their lifestyle expectations. But it isn’t always good medicine or in their patients’ best interests.
This leaves patients well-advised to practice their own brand of “defensive medicine” – which is the polar opposite of how physicians practice defensive medicine.
While physicians practice defensive medicine by overusing drugs, tests, and procedures, MedSmart consumers apply extra caution before consenting to medical interventions. And they do so in the context of knowing their biggest personal and family disease risks.
Know Your Family Medical History
Someday genetic profiling will help physicians determine your susceptibility to certain diseases and the probability of an adverse or favorable reaction to a particular drug (targeted therapies). Indeed, this already occurs with certain cancers and pediatric conditions like cystic fibrosis and lymphatic leukemia.
Genomics-based personalized medicine holds great potential for reducing treatment risks and optimizing results based on our personal DNA profiles. But there are tremendous obstacles to bringing genomic advances to the everyday practice of medicine, particularly lingering cultural resistance by many physicians to electronic medical records and decision-support tools based on clinical best practices.
These are essential components to bringing personalized medicine to the everyday practice of medicine. The continuing resistance by many in mainstream medicine to these essential infrastructure requirements means most patients cannot rely on this for protection in the near-term.
As long as this continues, the potential for personalized medicine will remain isolated to academic centers with the information infrastructure and cultural acceptance needed to make personalized medicine a reality. This is a problem in that academic medical centers are our most expensive medical settings, negating the potential for personalized medicine to reduce costs as well as medical errors and medication side effects.
Until these obstacles are overcome, a thorough family history remains your best means of identifying your genetic risks for certain diseases. Indeed, your “parental history trumps genes”  when it comes to heart attack risk. This makes it worth your time to nail down your family history to both inform your treatment decisions and focus your lifestyle choices for long-term risk reduction purposes.
Do You Live in a
Healthcare Hot Spot?
It’s also MedSmart to know what kind of local medical market you live in – more aggressive or less aggressive – and adapt your attitudes and behaviors accordingly (see dartmouthatlas.org). The more aggressive a medical market you’re in, the more likely you’ll receive medical interventions you don’t actually need – and defensive medicine will be the excuse offered to justify this over-treatment.
Those 5 out 8 Americans living in “Rip-Off” and “Watch-Your-Wallet” states (see Our Healthcare Sucks for definitions and listings of each) need to be especially vigilant in scrutinizing the medical interventions prescribed them – as do those in fraud “hot spots” like Miami, LA and Las Vegas.
Check the walls of your doctors’ offices for notices of ownership in facilities or services to which they refer you. Most states that allow physician self-referrals require posting of such disclosure notices, as does the AMA’s Code of Medical Ethics.
As a patient, you need to be especially wary of services performed at facilities in which your doctors have such a financial interest, as this financial conflict-of-interest may compromise your care and safety.Americans living in “Rip-Off” or “Watch-Your-Wallet” states need to be especially vigilant
Learn What the Evidence Supports
And all consumers need to insist on solid evidence of the risks and benefits of interventions being prescribed or recommended, including medications, as well as alternative treatment approaches and their risk-benefit profiles.
You also need to confirm what you’re told with your own research – the internet makes this easier than for prior generations of patients with credible sites offering in-depth medical information (start with the Choosing Wisely website’s lists of tests and procedures that are most overused and often unnecessary as determined by the medical specialty groups for those medical concerns).
And getting a second opinion before consenting to invasive procedures should become automatic behavior in your embrace of defensive medicine that works for you and not your doctors.
For many of us, this represents a sea change in our ready acceptance of our doctors’ recommendations. But when you consider the all-too-real risks of treatment-induced injury, assuming those risks for medical interventions you may not even need – simply to provide your doctors with greater legal comfort – just isn’t smart medical consumerism.
So are you ready to start thinking defensively about your medical needs?
 Family matters: Parental history predicts MI over genes and INTERHEART risk factors. Heartwire. theheart.org. 1/24/11.