Life, Death, and Heartache: Ethical Dilemmas Get Tougher


November 15, 2012

In This Article

The Ethics of Practicing Defensive Medicine

Is it ever acceptable to perform "unnecessary" procedures because of malpractice concerns?

The fear of missing a diagnosis and being sued won't go away, no matter how much legislators try to reduce healthcare costs. More than one half (55%) of physicians said that it was unacceptable to perform procedures for defensive medicine purposes, which is down slightly from the 61% who considered it unacceptable in Medscape's 2010 survey. About one quarter (23%) said it was acceptable, and 22% said it depends.

Respondents noted, "If it prevents a lawsuit, it's not unnecessary." Others said, "The lawyer down the street wants my lunch" and "If you've ever been sued for a missed diagnosis, you absolutely never want to be in that position again, so you'll test for everything."

"Performing tests for defensive medicine purposes is to protect the doctor, not to protect the patient," said Dr. Prager. However, he also noted that there's a difference between doing a test and performing an invasive procedure.

"Would I do an operation or invasive procedure for defensive medicine purposes? No, I wouldn't. The more invasive it is, the less ethical support for the doctor to have to protect himself. "But if the doctor will do a test, such as a blood test or radiography, I could see how that could be ethically justified. We have a lousy malpractice system, and defensive medicine can be ethically justified," said Dr. Prager.

Still, other physicians trashed the notion of defensive medicine, saying, "Defensive medicine is just an excuse for doctors to ratchet up the fees," and "If you're careful and thoughtful in your treatment, and you document your notes, you should not have to perform defensive tests."

"Of note, few ethical issues received a unified response," said Dr. Prager. "In many of the survey questions, the answers were spread somewhat evenly between yes, no, and it depends. This shows you that so much of what we deal with in medicine is complicated and nuanced."

To read about all the top ethical dilemmas for physicians, see Medscape 2012 Ethics Report: Physicians’ Top Ethical Dilemmas.