Is A Good Defense The Best Offense In Patient Care?

It is a sport adage that is frequently uttered by many a pundit at this time of year: “The best offense is a good defense”. Follow that up with “defense wins championships”, and you would probably have two of the most oft-used phrases in sport. With the NCAA men’s basketball tournament upon us, I am sure we’ll be hearing these a lot in the next few weeks.

The same thinking also exists in health care these days. We hear the phrase “defensive medicine” far too frequently anymore. Defense may win championships in football and basketball, but it doesn’t appear to be winning any health care championships.

So is defensive medicine really “the best offense”?

We are constantly hearing that physicians must prescribe all sorts of diagnostic tests and assessments for the sake of “defensive medicine”. Perform more tests and protect against liability. You have to send that patient for an MRI “just in case” – regardless of who owns it (but I digress).

The cost of health care is 30% higher simply because physicians feel compelled to practice “defensive medicine”. The standard story line then goes that if physicians didn’t have to worry about liability, the cost of health care would go down. It’s all in the liability, it’s time for tort reform, etc. Good defense.

We see this on a very regular basis in orthopedics. It’s name is “low back pain” – the poster child for over-utilization and defensive medicine.

Contrast that with evidence- or science-based clinical practice. The majority of clinical guidelines would indicate that most expensive assessment procedures are unnecessary for low back pain. What if physicians simply focused on evidence-based medicine using standards of care defined by countless research studies and clinical guidelines?

I am certainly not a lawyer but what I do know is what I hear from patients. Patients want to be heard. They want time. What would happen if physicians took more than a minute to not only listen to a patient but to perform a thorough history? My suspicion is that litigation claims would go down if patients felt they had time to talk to their doctor, to feel like they are being heard and that they are actively involved in the diagnostic process.

What does defensive medicine save the consumer, especially if it amounts to over-utilization and ignorance of the research?

There will always be the bad apples that will make claims, but these are not the vast majority. And even if there was litigation, would a lawyer not be able to defend a physician with good scientific research that indicates that he/she was simply performing at the current evidence-based standard of care?

Defense isn’t winning this championship.

Photo credits: Katie Stine