An article from June in the Archives of Internal Medicine — “Physicians’ Views on Defensive Medicine: A National Survey (Tara F. Bishop, MD; Alex D. Federman, MD, MPH; Salomeh Keyhani, MD, MPH) — said doctors report that they over-test because of fears of malpractice. I find this hard to believe. If doctors really thought a test didn’t have any possibility of showing a problem, how could malpractice result from not doing the test?
We don’t do MRIs or CTs on our dermatology patients. Those tests may get ordered in the ER because there is the possibility — albeit perhaps remote —that something serious is going on in the head.
I think what doctors are saying is that they do tests that are highly unlikely to be of value to make sure they don’t get sued for missing a highly unlikely event. But from the patient’s perspective, shouldn’t they be offered that test even if there is only a small, small chance that a problem will be detected? Unless the test is more dangerous than what might be found, offering the patient the test may be good medicine, not malpractice avoidance.