Are We Practising Defensive Medicine… or is this just Modern Medicine?

Are We Practising Defensive Medicine… or is this just Modern Medicine?

A few days ago, I had a patient with a clear cut diagnosis of an acute Tendo-Achilles tear. The history and examination findings fit. There was no diagnostic dilemma at all.

Ten years ago, I would’ve confidently told the patient, “This is the diagnosis. This is the surgery you need,” and I would’ve been comfortable taking that patient up for surgery based on clinical findings.

This time, despite having more experience and having seen many more of such cases, I still went ahead and ordered an MRI.

Not because I was unsure, or because I dint do a physical examination (I did). But because I wanted objective proof of the diagnosis. That got me thinking.

We probably label this as defensive medicine. That we’re doing tests solely for the sake of having a proof of the diagnosis if it were ever challenged in a court of law.

But is it really? And why would the law require something different if the correct medical protocol is followed?

Medicine has changed. Imaging has become more easily accessible, and affordable (atleast to a significant portion of the population). The demands of a patient, and the ‘standards’ expected of a doctor have changed as well. While 1 missed diagnosis out of 100 seem like a small number, the room for such errors is decreasing with advancement of healthcare and society at large.

So I asked myself a simple question:

If I were the patient, would I want the scan?

If it were non-invasive and inexpensive… Yes. Now that doesn’t mean all patients think similarly, and what is ‘expensive’ is subjective. But to me, it answered the question in my own mind, that performing some tests may not be ‘cost effective’ to an insurance provider or socialist healthcare set up, I would not want to be the one suffering, or have my patient effected due to it.

If you as a doctor are following medical protocol, I don’t see why any action needs to be taken only for the sake of protection in a court of law. Our actions need to be aimed at providing the best medical care to the patient, while abiding by the established medical protocols and laws.

Maybe this isn’t about fear of litigation alone. Maybe it’s about decreasing errors, reassurance (to patient and surgeon), and shared decision-making in a more informed (and sceptical) world. I convinced myself that it is my job to present the realistic picture to the patient, and eventually it is their choice.

So I don’t have a fixed answer, but I’d love to hear your thoughts:

What do you think ‘Defensive Medicine’ means practically and do you find yourself also forced to practise it?

Has reliance on investigations increased because we’re scared… or because expectations have changed?

Would you, as a patient, be satisfied with only a clinical diagnosis today?

Looking forward to an honest discussion.

#Healthcare #Medicolegal #ModernMedicine #Doctors