Defensive medicine in the emergency department. The clinicians’ perspective

Abstract

The overuse of medical services is regarded as a growing problem in Western countries, accounting for up to 30% of all delivered care, and carrying a higher risk of morbidity and mortality. One of the leading drivers toward medical overuse is the so-called defensive medicine, which is commonly defined as ordering of tests, procedures, and visits, or, at variance, avoidance of high-risk patients or procedures, aimed to reduce exposure to malpractice liability. Defensive medicine may increase the amount of care provided to the patients (<em>i.e.</em>, additional tests or therapies), change care or setting of care (<em>i.e.</em>, patients referred to another specialist or another healthcare facility), or impair the optimal care (<em>i.e.</em>, refusing risky patients). Some studies seem to confirm a large utilization of defensive medicine in the emergency departments. This article tries to analyze some key points capable to pave the way to a consistent reduction of defensive medicine, thus defining a hierarchical list of priorities, keeping the patient’s health always at the center of the matter.