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Don't Be So Defensive<
by: Theresa Defino
Icy Relationships With Patients Can Increase Your Malpractice Risk And Cause You To Practice Defensive Medicine. Next Time, Think Twice Before Ordering That Test. Elaine: You are not going to believe what happened to me at the doctor's office today. In this Seinfeld episode, Elaine was branded as difficult and given poor treatment -- actually no treatment at all. No doubt you have run into your share of "Elaines" over the years -- difficult patients who, say, refuse to wear a gown (as Elaine did), or act in ways that seem in inappropriate, quirky, even scary. Do you treat them differently, thinking they might sue you?
And you are not alone. Some 93 percent of physicians told researchers in a recent Columbia University-led study that they had practiced defensive medicine. Defensive medicine adds an estimated 10 percent to 20 percent of costs to the nation's already bloated healthcare system. But the problem is not purely financial. Access and quality of care are also compromised, and the doctor-patient relationship deteriorates. Fear of malpractice litigation and spiraling malpractice insurance premiums contribute to this situation. You can't fix the malpractice crisis. But you can avoid being sucked into the defensive medicine trap. Begin with a better understanding of what constitutes defensive medicine, learn what sort of patients may trigger you to overtreat or undertreat them, and increase your awareness of the reasons you are ordering those expensive, perhaps risky, tests. Ultimately you will strengthen your bond with your patients and reduce your chances of being sued. Defining Defensive Medicine The Columbia study defined defensive medicine as "a deviation from sound medical practice that is induced primarily by a threat of liability." In May 2003, coauthor William M. Sage, a physician and law professor at Columbia, and his colleagues surveyed more than 800 Pennsylvania physicians who practiced emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology. Defensive activities common across all specialties (except radiology) included ordering more tests, such as MRIs and CT scans or prescribing more medications than medically necessary; referring patients to specialists in inappropriate circumstances; suggesting invasive procedures to confirm diagnoses; avoiding certain procedures or interventions; and avoiding caring for "high-risk" patients. Pennsylvania physicians were surveyed because their malpractice climate is particularly brutal: several insurers have left the state and premiums have tripled for some physicians. Sage thought the state would produce the most "dramatic" finding. Even so, he was shocked by the conclusions. "I was surprised by the high prevalence of defensive medicine and by the specific stories the doctors told us," Sage says. "We asked, 'If you are in practice, what was the last [defensive] thing you did?' We got a l< |
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