Defensive medicine: It is time to finally slow down an epidemic
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Date
2018-10-06
Authors
Vento, Sandro
Cainelli, Francesca
Vallone, Alfredo
Journal Title
Journal ISSN
Volume Title
Publisher
World Journal of Clinical Cases
Abstract
Defensive medicine is widespread and practiced the
world over, with serious consequences for patients,
doctors, and healthcare costs. Even students and residents
are exposed to defensive medicine practices and
taught to take malpractice liability into consideration
when making clinical decisions. Defensive medicine is
generally thought to stem from physicians’ perception
that they can easily be sued by patients or their relatives
who seek compensation for presumed medical errors.
However, in our view the growth of defensive medicine
should be seen in the context of larger changes in the
conception of medicine that have taken place in the
last few decades, undermining the patient–physician
trust, which has traditionally been the main source of
professional satisfaction for physicians. These changes
include the following: time directly spent with patients
has been overtaken by time devoted to electronic health
records and desk work; family doctors have played a
progressively less central role; clinical reasoning is being
replaced by guidelines and algorithms; the public at large
and a number of young physicians tend to believe that
medicine is a perfect science rather than an imperfect
art, as it continues to be; and modern societies do not
tolerate the inevitable morbidity and mortality. To finally
reduce the increasing defensive behavior of doctors
around the world, the decriminalization of medical errors
and the assurance that they can be dealt with in civil
courts or by medical organizations in all countries could
help but it would not suffice. Physicians and surgeons
should be allowed to spend the time they need with their
patients and should give clinical reasoning the importance
it deserves. The institutions should support the doctors
who have experienced adverse patient events, and the
media should stop reporting with excessive evidence
presumed medical errors and subject physicians to “public
trials” before they are eventually judged in court.
Description
Keywords
Adverse event, Clinical reasoning, Defensive medicine, Doctor-patient relationship, Healthcare cost, Medical education, Medical error
Citation
Vento, Sandro; Cainelli, Francesca; Vallone, Alfredo. (2018) Defensive medicine: It is time to finally slow down an epidemic. World Journal of Clinical Cases