Defensive medicine: why doing less can be the hardest thing

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By Michael Marshall

Doctors sometimes make clinical decisions not because they are necessary, but to avoid potential complaints. But when does this count as "defensive medicine" and how big a problem is it really?

Many doctors have done it – most, even, according to recent surveys.

It can take different forms: a patient comes in with a complaint that nobody can really do anything about, so to keep them happy you refer them to a specialist even though you know it won’t do any good, for instance. Or the patient has an infection that’s probably caused by a virus, but they demand antibiotics and you feel sure they’ll complain if they don’t get them, so you give in and prescribe them anyway.

Defensive medicine is fear dressed up as thoroughness or completeness

The definition of “defensive medicine” is a bit loose, but generally speaking, it refers to medical decisions made not because they will be clinically effective or worthwhile, but rather to avoid an argument, formal complaint or potential lawsuit.