II. Definitions

  1. Defensive Medicine
    1. Deviation from evidence-based medical decisions due to liability threat
    2. Example: Ordering advanced imaging (e.g. CT C-Spine) despite reassuring decision rules (e.g. NEXUS Criteria)
  2. Sub-types of Defensive Medicine
    1. Assurance behavior
      1. Additional services offered that add little medical value
    2. Avoidance behavior
      1. Replacing care by referring to another medical provider
      2. Reducing care by refusing to treat a patient

III. Epidemiology

  1. Defensive Medicine is practiced by a majority of emergency providers (>90%) in a majority of cases
  2. Annual U.S. Cost of additional tests and referrals: 55 to 200 billion/year
  3. Studdert (2005) JAMA 293(21): 2609-17 [PubMed]

IV. Adverse Effects

  1. Unnecessary tests
    1. Higher costs
    2. False Positives resulting in unnecessary risky interventions (e.g. Anticoagulation, angiography, CT surveillance)
    3. Bottle necks (e.g. ER and hospital bed space, advanced Imaging Resources)
  2. Unnecessary medications
    1. Antibiotic Overuse
      1. Does not improve patient satisfaction
      2. Ong (2007) Ann Emerg Med 50(3): 213-20 [PubMed]
    2. Opioid overuse
  3. Unjustifiable care
    1. Adverse outcomes due to over-testing and over-treatment contrary to standard of care practice is not legally defensible

V. References

  1. Weinstock et. al. in Majoewsky (2012) EM:Rap 12(8):1-2

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