Medical Ethics Discussion Sample
Fernando Centeno
Defensive Medicine and Medical Malpractice Law
This forum seeks to explore the issue of so-called "defensive medicine," an issue that greatly impacts
healthcare in America. To understand the issue, we must discuss it from a medical standpoint but also
from the view of the patient and the lawmaker. We want to question why the issue exists in this
magnitude and how doctors, patients and officials should address it.
Background Information
Defensive medicine is the practice of deviating from normal medical treatment to avoid having to defend
oneself from a patient in a court of law. While this definition may suggest simply taking more
precautionary measures, as malpractice laws are intended to ensure, it's a major issue that concerns
doctors, patients and lawmakers nationwide.
The practice of defensive medicine entails the use of unnecessary and costly tests such as MRIs and
biopsies along with more invasive and potentially dangerous treatments and even the avoidance of any
treatment at all to reduce doctor liability in case the patient is harmed, not fully cured or experiences any
abnormal symptoms. Defensive medicine is estimated to cost as much as $487 billion a year in the
United States, a price paid for with health insurance premiums and taxpayer dollars.
A study of 800 physicians in Pennsylvania reported 92% were ordering imaging tests for assurance and
42% were declining high risk procedures and avoiding complicated patients. A similar survey by the
Official Journal of the Congress of Neurological Surgeons reported that 75% of these professionals were
practicing defensive medicine to avoid finding themselves in court with a patient as plaintiff.
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From a physician's perspective, the burden of the status quo is fairly understandable. The undue
precautions represent an excess in work and a source of anxiety for doctors who fear for their
professional reputation to be compromised. They also fear the reprimands and consequences of
not practicing these defensive techniques, including rising malpractice insurance premiums and
litigation.
Some policy-makers argue that the complaints by doctors are based on the malpractice insurance
costs which vary based on predictable insurance cycles and that there is little or no actual effect in
these insurance costs from defensive medicine.
Patients find themselves at a definite disadvantage when they or their insurance has to pay for
expensive medical costs.
Changing Legislation
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A recent attempt at dealing with defensive medicine practices is the Patients' Compensation
System (PCS) whose ratification and implementation is being attempted by Florida, Georgia,
Tennessee, Maine and Montana.
This system would eliminate malpractice lawsuits and instead run patients complaining of
malpractice through a health advisory panel with healthcare experts (as opposed to a
conventional jury). If this panel could find that a preventable injury was not addressed the patient
would be compensated.
A study from Emory University in Atlanta estimated this system would save Georgia alone $7
billion over the next 10 years.
The system would allegedly reduce the amount of meritless lawsuits and speed up the process of a
malpractice claim.
Medical Ethics Discussion Sample
Fernando Centeno
Table 1: Current malpractice litigation process, from the Connecticut General
Assembly
Discussion Questions:
1. Should doctors place responsibility for their patients, including the costs of defensive
medicine on these patients and especially those who are uninsured, over their own job security?
2. If you were a legislator, would you side with the concerns of the doctors, a relative minority,
over the patients who benefit from malpractice lawsuits?
3. Should the patient or the legislator be concerned that a system like the PCS could be too
lenient? Could the healthcare experts be partial to the doctors and undermine real malpractice
cases?
4. If the proposed PCS proved to be inadequate, what alternative policy changes could be made
to reduce defensive medical practices?
5. Can we realistically expect health care costs to go down significantly with a change in
legislation, or will physicians (many who own and profit from the costly equipment themselves)
still practice defensive medicine? Should legislation target the practice itself and not just the
cause for the practice?
Medical Ethics Discussion Sample
Fernando Centeno
Works cited
Connecticut General Assembly. "Medical Malpractice Insurance Rates Final Report." Medical Malpractice
Insurance Rates Final Report. Connecticut General Assembly, 2004. Web. 12 Sept. 2015.
Hermer, Laura D., and Howard Brody. "Defensive Medicine, Cost Containment, and Reform." Journal of
General Internal Medicine. Springer-Verlag, 9 Feb. 2010. Web. 12 Sept. 2015.
Segal, Jeffrey. "Reforming Defensive Medicine Is Key To Reducing Healthcare Costs." The Daily Caller.
Neil Patel, 11 Sept. 2015. Web. 12 Sept. 2015.
Sekhar, M. Sonal, and N. Vyas. "Defensive Medicine: A Bane to Healthcare." Annals of Medical and
Health Sciences Research. Medknow Publications & Media Pvt Ltd, June 2015. Web. 12 Sept.
2015.
Shinkman, Ron. "Patient Compensation System Could Replace Malpractice Torts." FierceHealthFinance.
Fierce Network, 9 Nov. 2014. Web. 12 Sept. 2015.