Defensive Medicine

I came across this article from the New York Times Op-Ed page, which really struck a chord with me.

More Treatment, More Mistakes written by Dr. Sanjay Gupta.

Certainly many procedures, tests and prescriptions are based on legitimate need. But many are not. In a recent anonymous survey, orthopedic surgeons said 24 percent of the tests they ordered were medically unnecessary. This kind of treatment is a form of defensive medicine, meant less to protect the patient than to protect the doctor or hospital against potential lawsuits.

I suppose the “potential lawsuits” are more of a problem in the United States, but certainly we over-prescribe and over-treat in Canada as well. Since when did medicine become a discipline in which health professionals get bullied into prescribing or investigating any and all ailments?

Patients have come to expect going to the hospital means they will “get” something out of the visit — be it medication, blood work, or x-ray etc. On many occasions I’ve had to tell patients that nothing but some r&r will mend them, and they doubt me, insisting that something can be given. If your healthy baby is crying, it’s a good sign. Please don’t bring them in at 3 am, because they will fall asleep in your arms, and I will tell you to go home. If you have a sore throat, give it a few days to go away, please do not come telling me you need antibiotics. But do come in if you have a festering wound that you got a week ago, and is now looking like caca.

I had a memorable visit a couple weeks ago. A parent brought in a toddler because when they were changing baby boy, he said “ouch” when they were wiping him. They said they felt a “lump” in his groin. So I go in and take a look, making sure baby doesn’t have a hernia or something. I asked if they had any problems with descending testicles, and parent says no. I try and find this “lump” where parent is concerned. And it’s no longer in the upper scrotum where parent found it earlier. Well, I tell them that the testicles are movable, olive shaped lumps that will be uncomfortable if you move them in the scrotum. And that is probably what happened while changing baby boy…

Yes, it’s a miracle that baby boy was even born. I feel the reproductive organs are barely addressed in the school system here — god forbid, children learn about sex.


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