Defensive medicine: testing and treatment that is not medically necessary but is performed by the clinician to avoid legal liability
Is unethical and should be avoided because it increases risk of patient harm and does not add significant benefits (e.g., an unnecessary CT scan causes radiation exposure)
Clinicians should openly communicate with patients about the risks and benefits of tests or treatments that they believe are not medically necessary.
Prevention
Tort Reform:
Caps on non-economic damages (pain and suffering).
Pre-trial screening panels to eliminate frivolous claims.
“Safe Harbor” laws: Legal protections for physicians who strictly adhere to validated clinical practice guidelines (e.g., Choosing Wisely, ACC/AHA, USPSTF). c
Clinical Decision Support (CDS): Electronic health record (EHR) integrated tools (e.g., Wells criteria, PERC, Canadian CT Head Rule, Ottawa Ankle Rules) that objectify decisions to omit imaging.
Alternative Dispute Resolution: Implementation of enterprise-wide disclosure, apology, and early compensation models.