No doctor wants to spend their career with one eye over the shoulder at all times due to the fear of a lawsuit. Yet, the threat of a medical malpractice claim can influence the way many providers approach clinical decision-making. That can turn into “defensive” medicine.
In many cases, the strongest protection against malpractice claims comes from high-quality, evidence-based care supported by clear communication and thorough documentation. Good medicine and good risk management often go hand in hand.
What is defensive medicine?
Defensive medicine generally refers to medical decisions driven primarily by concern about potential litigation rather than the patient’s clinical needs. It may involve ordering additional tests, consultations or procedures – all to create a more detailed record and to reduce the perceived risk of a missed diagnosis.
Examples of defensive medicine may include:
- Ordering imaging or lab tests that are unlikely to change the patient’s treatment plan
- Referring patients to specialists primarily to reduce perceived liability
- Hospitalizing patients who could safely be treated as outpatients
- Performing diagnostic procedures with little expected clinical benefit
- Avoiding high-risk patients or procedures out of fear of litigation
Although these decisions are often made with good intentions, they can increase healthcare costs, expose patients to unnecessary risks and delay appropriate treatment.
There are better alternatives. Reducing malpractice risk does not require abandoning sound clinical judgment. Instead, physicians can often better protect themselves by:
- Following accepted standards of care and evidence-based clinical guidelines
- Documenting the clinical reasoning behind important decisions, including why certain tests or treatments were or were not recommended
- Documenting informed consent discussions that explain risks, benefits and alternatives
- Giving patients clear discharge instructions, follow-up recommendations and return precautions
- Listening carefully to patient concerns and addressing questions openly
- Maintaining accurate, timely and complete medical records
No strategy can eliminate the possibility of a malpractice claim. However, when a claim does arise, the focus is rarely on whether every conceivable test was ordered. More often, the key questions are whether the provider exercised reasonable clinical judgment, met the applicable standard of care and created a medical record that accurately reflects the decision-making process. In many cases, that approach provides a stronger malpractice defense than practicing medicine out of fear ever could.
