II. Definitions
- Defensive Medicine
- Deviation from evidence-based medical decisions due to liability threat
- Example: Ordering advanced imaging (e.g. CT C-Spine) despite reassuring decision rules (e.g. NEXUS Criteria)
- Sub-types of Defensive Medicine
- Assurance behavior
- Additional services offered that add little medical value
- Avoidance behavior
- Replacing care by referring to another medical provider
- Reducing care by refusing to treat a patient
- Assurance behavior
III. Epidemiology
- Defensive Medicine is practiced by a majority of emergency providers (>90%) in a majority of cases
- Annual U.S. Cost of additional tests and referrals: 55 to 200 billion/year
- Studdert (2005) JAMA 293(21): 2609-17 [PubMed]
IV. Adverse Effects
- Unnecessary tests
- Higher costs
- False Positives resulting in unnecessary risky interventions (e.g. Anticoagulation, angiography, CT surveillance)
- Bottle necks (e.g. ER and hospital bed space, advanced Imaging Resources)
- Unnecessary medications
- Antibiotic Overuse
- Does not improve patient satisfaction
- Ong (2007) Ann Emerg Med 50(3): 213-20 [PubMed]
- Opioid overuse
- Antibiotic Overuse
- Unjustifiable care
- Adverse outcomes due to over-testing and over-treatment contrary to standard of care practice is not legally defensible
V. References
- Weinstock et. al. in Majoewsky (2012) EM:Rap 12(8):1-2