Defensive medicine, also called defensive medical decision making, refers to the practice of recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but mainly serves to protect the physician against the patient as potential plaintiff. Defensive medicine is a reaction to the rising costs of malpractice insurance premiums and patients’ biases on suing for missed or delayed diagnosis or treatment but not for being overdiagnosed.
Physicians in the United States are at highest risk of being sued, and overtreatment is common. The number of lawsuits against physicians in the USA has had a substantial impact on the behavior of physicians and medical practice. Physicians order tests and avoid treating high-risk patients (when they have a choice) to reduce their exposure to lawsuits, or are forced to discontinue practicing because of overly high insurance premiums.[1] This behavior has become known as defensive medicine, "a deviation from sound medical practice that is indicated primarily by a threat of liability".
In India, a rise of physical attacks on practitioners and lack of support from public and government systems are the prime reasons for defensive medicine.
In 2004, the case of Dr. Daniel Merenstein triggered an intensive debate in scientific journals and media on defensive medicine (e.g.,[2][3]) Following the guidelines of several well-respected national organizations, Merenstein had explained the pros and cons of prostate-specific antigen (PSA) testing to a patient, rather than simply ordering the test. He then documented the shared decision not to order the test. Later, the patient was diagnosed with incurable advanced prostate cancer, and Merenstein and his residency were sued for not ordering the test. Although Merenstein was acquitted, his residency was found liable for $1 million.[4]
Ever since this ordeal, he regards his patients as potential plaintiffs: 'I order more tests now, am more nervous around patients: I am no longer the doctor I should be'.[5]
Rates of Caesarean section have been found to increase by an average of 8% as seen after 2.5 years following a related medical error.[6]
In a study with 824 US surgeons, obstetricians, and other specialists at high risk of litigation, 93% reported practicing defensive medicine, such as ordering unnecessary CT scans, biopsies, and MRIs, and prescribing more antibiotics than medically indicated.[1]
In Switzerland, where litigation is less common, 41% of general practitioners and 43% of internists, reported that they sometimes or often recommend PSA tests for legal reasons.[7]
The practice of defensive medicine also expresses itself in discrepancies between what treatments doctors recommend to patients, and what they recommend to their own families. In Switzerland, for instance, the rate of hysterectomy in the general population is 16%, whereas among female doctors and female partners of doctors it is only 10%.[8]