8


On the defensive


Many doctors have an inflated perception of the risk of being sued, so practise with a dagger at their back. Sara Williams asks: are they missing the point?


A


US student went to her local emergency department suffering from stomach pains. A


computed tomography scan revealed an ovarian cyst; she then presented her father with an $8,500 bill. Her father, a medical director, argued that a history, a pelvic examination and an ultrasound would have been adequate.1 The hospital defended the CAT


scan claiming that an ultrasound may have missed something more serious, such as appendicitis or a kidney stone. Although her father agreed, he argued that the hospital should have started with the ultrasound and undertaken the CAT scan only if necessary. He then contacted the national media, accusing the hospital of performing defensive medicine. Do you order every test on every


patient? Do you avoid certain procedures for fear of being sued over a clinical stumble? Do you


refer every patient with a cough? If you answered “yes” to all of these,


you are practising defensive medicine. As global medicine has become more litigious, such performance patterns are becoming more widespread. This “retrospectoscope” phenomenon not only draws attention away from good clinical diagnosis, in favour of tick-box medicine, but it could put patients at risk through risky procedures by medicalising the well patient.2


WHY DO DOCTORS PRACTISE DEFENSIVELY?


Media scrutiny A Casebook survey (see page 9 for more information) revealed that 70% of MPS members identified media criticism of health professionals as a contributing factor to them practising defensively. In countries such as Singapore and Hong Kong, the press


are very aggressive and critical of doctors. As most of the work is private practice, such criticism could affect their reputation and thus their income.


Non-monetary cost of litigation The personal impact of litigation, such as the value of lost time, emotional energy and reputational damage, is often perceived to be more costly than the cost of taking precautions.3


Hero complex If a doctor ordered a significant number of tests, where the prevalence of disease was low, they would occasionally pick up on early-stage malignancies and other pathologies, earning them a reputation as a great doctor or a “hero” to patients.


Societal expectations Speaking last year at a patient safety conference, internationally-renowned


SPECIAL FEATURE


UNITED KINGDOM CASEBOOK | VOLUME 19 | ISSUE 1 | JANUARY 2011 www.mps.org.uk


FOTOCROMO/iStockphoto.com


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