Search PubMed⌕ Search

SEARCH · Search PubMed

Results for “Defensive Medicine”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 127 records · Page 7Linked to original sources
PubMedDate not supplied

Indecent medicine: in defense of the absolute prohibition against physician participation in torture.

In a recent article, Gross (2004) argues that physicians in decent societies have a civic duty to aid in the torturing of suspected terrorists during emergency conditions. The argument presupposes a communitarian society in which considerations of common good override questions of individual rights, but it is also utilitarian. In the event that there is a ticking bomb and no other alternative available for defusing it, torture must be used, and physicians must play their part. In an earlier article, Jones (1980) also argues in favour of physician participation in torture, going so far as to enthusiastically endorse the allocation of research resources as well to ensure that the ability to meet emergency situations is as efficient as scientifically possible. I argue against both these views and defend the absolute prohibition against torture generally, and against any participation by physicians in particular. I show that these arguments are incompatible with liberal or decent societies, and that the institutional requirements for making torture effective would constitute an unacceptable degradation both of medical ethics and practice, as well as of political institutions in general.

Civil Rights↗
PubMed1997

Defensive testing in Dutch family practice. Is the grass greener on the other side of the ocean?

BACKGROUND: Ordering laboratory tests and diagnostic imaging can be part of the defensive behavior of the physician. How often does this occur in family practice in the Netherlands? Defensive behavior is defined as a clear deviation from the family physician's usual behavior and from what is considered to be good practice in order to prevent complaints or criticism by the patient or the patient's family. METHODS: Over a 1-year period, 1989-1990, 16 family physicians in 11 practices with 31,343 patients recorded all episodes of care involving an order for laboratory tests or diagnostic imaging or both (n = 8897). The physicians selected one or more reasons to order each test from a fixed list of clinical considerations. In addition, they recorded whether they acted defensively for every test order. RESULTS: The participating physicians reported that some degree of defensive medicine was associated with 27% of all test orders. Defensive testing varied with the clinical reasons to order a test: the wish to exclude a disease or to reassure the patient was a much stronger motive for defensive testing than the intention to confirm a diagnosis or to screen. Defensive tests generally resulted in fewer abnormal findings. CONCLUSIONS: Defensive testing is an important phenomenon in Dutch family practice: it forms a well-defined element of practice despite the variations implicit in the different clinical reasons to order a test. Defensive testing is associated with a lower probability of finding an abnormal test result. The analysis of family physicians' clinical reasons for ordering tests becomes more meaningful when defensive testing is included.

Cross-Cultural Comparison↗
PubMed1980

Negligence and the surgeon.

Increasing litigation in recent years makes it more and more necessary for the surgeon to be on his guard against actions or omissions that might be construed as professional negligence. Some of the more common causes of such negligence and their avoidance are discussed. If the current tendency of the courts to interpret mistakes and errors of judgment as negligence continues some change in the law will be essential if the practice of defensive medicine is to be avoided.

Clinical Competence↗
PubMed2000

The effect on medical practice of disciplinary complaints: potentially negative for patient care.

AIM: To explore the personal and professional effect on general practitioners (GPs) of receiving a complaint against them to the (former) Medical Practitioners Disciplinary Committee, when the complaint did not proceed to a formal hearing. METHODS: Ten GPs were interviewed by telephone, following an enrollment procedure that protected identities from the interviewer. Qualitative (thematic) analysis of indepth interviews was used to categorise doctors' perceived effects of complaints on practice and to develop a theory on why such effects should occur. RESULTS: Receipt of a complaint had both short- and long-term effects on the doctor, and on their views of patients, society and the disciplinary process. There were immediate negative emotional responses that were sustained in the long-term in a way that adversely effected doctor-patient relationships beyond the relationship with the original complainant. Doctors reported short-term changes in their practice of medicine, with reduced ability to work confidently and decisively. Doctors also reported altered practice in the long-term in the direction of defensive medicine, by withdrawing from providing some services and avoiding perceived at-risk activities. CONCLUSION: The impact of a complaint on the self of the doctor suggests a shame response. There may be a need for the relevant professional college to establish a rapid response 'crash team' to minimize the negative personal and professional effects of a complaint, even when the complaint does not proceed to a formal hearing.

Attitude of Health Personnel↗
PubMed1995

[Legal problems in obstetrics. On the "liability of the expert witness"].

There has been a depressing increase in claims for damages and associated civil code and legal code proceedings in medicine in general (as the term "defensive medicine" illustrates) that exercises considerable influence on medical activities in obstetrics, not always to the benefit of the patients. In what manner and to what extent the expert can and must influence legal decisions, is demonstrated by means of a few examples such as management of parturition in case of breech presentation, causal assessment of psychomotoric retardation in postnatal life and the management of dystocia in shoulder presentation. If judges and attorneys are blamed-as is often the case-one should always also consider the significance of expertising activities. Typical errors occurring during expert assessment are pointed out. This shows the high degree of responsibility that has to be shouldered by the expert when he advises judges and/or attorneys. Expertising activities should be directed to a greater measure than in recent years, at delivering expertises restricted to the factual situation without involving emotions. This would at the same time reduce the influence of judges, attorneys and lawyers on our medical activities, an influence that has recently been much deplored.

Birth Weight↗
PubMed2002

Litigation: a threat to obstetric practice?

Claims that the practice of obstetrics is in crisis appear regularly in the media, but evidence for the claims is scarce. This article examines a range of evidence from Australia and overseas and explores the relationship between obstetric practice and litigation. While anecdotal evidence abounds, there is no hard evidence to confirm that litigation is the threat to obstetric practice that many practitioners strongly believe it is. It is likely that such practitioners respond by practising defensive medicine but this is very difficult to measure.

Attitude of Health Personnel↗
PubMed1998

["Evidence-based medicine"--guidelines as a threat or necessity for physician and patient?].

Guidelines derived from 'evidence-based medicine' are supposed to provide assistance and information in order to improve diagnosis and therapy of individual patients and build up confidence in medical decisions. Guidelines possess no direct legal power. The doctor's freedom of decision must be warranted. Inadequate guidelines may have serious consequences: curtailment of therapeutic freedom, hampering of medical progress, deterioration of the relationship between doctors and their patients, risk of legal implementation and emergence of a defensive medicine.

Defensive Medicine↗
PubMed1995

Health care reformation and the need for tort reform.

Health care reform is changing the medical profession and the way physicians manage their patients, including reducing the incentive to practice defensive medicine. Conflicting pressures on physicians make this an ideal time for medical malpractice tort reform.

Defensive Medicine↗
PubMed1998

[Medical negligence in Puerto Rico: 1990-1996].

The purpose of this communication is to present the statistical information of the medical and hospital professional liability situation in Puerto Rico from 1990 to 1996. The Medical Institutional liability is a topic of great relevancy and importance to the people of Puerto Rico and the leaders responsible for establishing policies for the health care services. The Reports on Medical and Hospital Professional Liability from 1991 to the 1996 produced by the Examining Physicians Board were reviewed. The liability claims from 1991 to the 1996 totaled 4054. During the seven years analyzed, 3506 cases were closed against physicians and institutions, a payment was issued in 1272 cases (36.3%), for a total compensation of $56,268,053. The risk of a legal claim is greater for the group of Plastic Surgeons and Emergency Medicine. The probability of a plaintiff receiving a compensation payment in a case of medical malpractice is approximately 36%, usually receiving a third of the total of the award as suggested by the medical literature. A thoughtful analysis of the current medical liability situation and defensive medicine should be done with the purpose of protecting the fiduciary function of the physicians with respect to the health of their patients, this is the function that guarantees a physician-patient relationship that is healthy, righteous and empathic.

Defensive Medicine↗
PubMed1994

[Forensic medical expertise in ophthalmologic practice].

The author evaluates 75 cases of his forensic medical expertise as ophthalmologic examiner. He draws attention mostly to those cases which are of interest not only for ophthalmologists but also for other medical specialists. In particular, he investigates the three most frequent groups of cases (questionability of reading capability, injury, detachment of retina), in connection with practical examples. He also discusses questions of defensive medicine as well as the problems of latency between noxa and diagnosis. Besides, he refers to the ophthalmologic aspects of the decreased ability to work.

Defensive Medicine↗
PubMed1997

Massachusetts Risk Management Survey (MaRMS) of teaching hospital physicians.

OBJECTIVE: To assess and compare the risk management knowledge of physicians from Massachusetts teaching hospitals. DESIGN: A survey. SETTING: Participating Massachusetts teaching hospitals. PARTICIPANTS: 639 of some 2,000 staff physicians of participant hospitals who were sent surveys. An additional 174 postgraduate year 1 (PGY1) and PGY3 house officers also completed the survey. MAIN OUTCOME MEASURES: Percent of questions answered correctly, and comparisons between staff physicians and house officers. RESULTS: Staff physicians scored higher (87%) than PGY1s and PGY3s combined (81%), P<0.001. Scores among staff physicians did not differ according to field of medicine, age, proportion of time spent in clinical practice, or years in practice. PGY3s did not score significantly higher than PGY1s (82% vs. 80%). Some 40% of physicians said they ordered more tests than necessary because of malpractice worries; they indicated 72% of their colleagues do so as well. Physicians in obstetrics-gynecology and emergency medicine were more likely to respond yes to this question than physicians in other fields of medicine (P<0.001), as were physicians who had been defendants in a malpractice suit (88 P=0.013). CONCLUSIONS: Surveyed staff physicians have an adequate risk management knowledge. Training directors should encourage house officers to attend risk management programs to improve their knowledge. Physicians might overestimate the amount spent on defense medicine based on their perceptions of other physicians.

Adult↗
PubMed1997

[Treatment failure from the viewpoint of forensic medicine].

It is the nature of a disease that it may not only improve but also deteriorate even when under medical treatment. Medical treatment thus constitutes a high-risk activity. The great advances in medical diagnosis and treatment in recent years have increased this risk still further. The medical profession is becoming increasingly unsettled and worried about claims of treatment errors, not least because-of the increasing pressure from the public and media. This has wrongly led to the development of "defensive medicine" such as has already started to become established in the USA. The medical expert should stand as a mediator between medicine and law, and thus be in a position to clear up misunderstandings between the two disciplines with their different mind sets. For these reasons, a forensic specialist should be appointed as an expert whenever possible; he may be proposed to the examining judge as an additional expert in the field in question to answer special questions put to him. This article discussed the basis on which an expert medical opinion should be provided in relation to an injury arising as a result of a treatment.

Defensive Medicine↗