Defensive Medicine Enters Med Student Curriculum


A recent article in Academic Medicine examines medical students' and residents' experiences learning the practice of defensive medicine, which the authors define as deviation from sound medical practice due to a perceived threat of malpractice liability. The authors found that while defensive medicine may not be written into the curriculum, it is still being taught.

"We hope this study sheds light on the fact that defensive medicine practices are frequently recommended by faculty as part of the informal curriculum," says Kevin O'Leary, MD, MS, associate chief of hospital medicine at Northwestern University Feinberg School of Medicine in Chicago and lead author of the study. Better, he says, for medical training to reframe the discussion on the risk for preventable adverse events or injuries to patients and the provision of safer patient care, which is not only more ethical but also more likely to reduce malpractice exposure.

A cross-section of 126 fourth-year medical students and 76 third-year residents at Northwestern were asked how often their attendings explicitly recommended taking liability concerns into account when making medical decisions. Forty-one percent of med students and 53% of residents responded that this occurred sometimes or often. Ninety-two percent of medical students and 96% of residents reported encountering the provision of additional services of little clinical value. Withholding necessary procedures out of malpractice concerns was less common.

One student surveyed said, "All the time in the outpatient setting, [my] attending reminds us that we're in a service industry dealing with litigious people and that sometimes you have to do the extra scan or prescribe the antibiotics that are unnecessary to keep people from suing you."

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