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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Related Studies

Ontology: Defensive Medicine (C0011143)

Definition (MSH) The alterations of modes of medical practice, induced by the threat of liability, for the principal purposes of forestalling lawsuits by patients as well as providing good legal defense in the event that such lawsuits are instituted.
Concepts Health Care Activity (T058)
MSH D003675
English Defensive Medicine, Defensive Practice, Defensive Practices, Medicine, Defensive, DEFENSIVE MED, MED DEFENSIVE, defensive medicine
Swedish Defensiv medicin
Finnish Defensiivinen lääketiede
Japanese 防衛医療, 医療過誤予防医学, 保身医療, 医療過誤予防的診療
French Pratique médicale défensive, Médecine défensive
Polish Medycyna defensywna, Medycyna obronna
Czech defenzivní medicína
Norwegian Defensive Medicine
German Defensivmedizin, Defensive ärztliche Behandlung
Italian Medicina tutelativa
Dutch Defensieve geneeskunde, Defensieve geneeskundige behandeling
Portuguese Medicina Defensiva, Prática Defensiva
Spanish Medicina Defensiva, Práctica Defensiva