{
  "id": 10018400,
  "title": "We've Seen Defensive Medicine, but It Was Never Taught",
  "url": "https://urgent.news/2026/09/26/weve-seen-defensive-medicine-but-it-was-never-taught",
  "topic": "health",
  "section": "Health & Medicine",
  "published": "2026-09-26T16:00:00.000Z",
  "source": {
    "name": "MedPage Today",
    "slug": "medpage-today",
    "url": "https://www.medpagetoday.com/opinion/second-opinions/123144"
  },
  "original_language": "en",
  "account": "In a pediatric emergency department, a 12-year-old boy presents with right lower quadrant pain, leading to immediate vital sign checks, blood sampling, and a bedside ultrasound. The diagnosis is appendicitis, and he is admitted for surgery the following day. However, his parents request a CT scan, which is ordered despite the clear diagnosis. The family faces a significant bill for the scan, as the results do not alter the treatment plan. This scenario is not unique; it is a common occurrence during medical school clerkships, where residents and attending physicians question the necessity of such scans. The underlying reason, though not always explicitly stated, is to protect physicians from potential legal repercussions. This phenomenon, known as defensive medicine, stems from the fear of lawsuits following the 1970s malpractice crisis, which saw a surge in claims and insurance premiums. It is estimated that 28% of orders and 13% of costs in a large medical center were at least partially defensive. As future physicians, we recognize that medicine serves two audiences: the actual patient and the hypothetical lawyer who may question our decisions. This dual focus gives rise to defensive medicine. During our training, we study evidence-based practice guidelines, but an unofficial syllabus emerges from daily clinical practice. Defensive medicine is evident when emergency physicians order extra imaging or cardiac surgeons refer patients to palliative care due to perceived perioperative risks. While physicians navigate a system where the consequences of missing a diagnosis can be severe, the consequences of additional tests are usually minimal. This decision-making process often conflicts with the algorithms we have memorized. Despite the potential risks, physicians who order defensive tests may not be acting out of malice but rather a desire to minimize personal risk and anticipated regret. While some may argue that additional scans are harmless, they can have negative consequences for both patients and hospitals. Unnecessary testing can expose patients to radiation, lead to false positives, and cause mental distress, while hospitals may face financial burdens due to slower workflows and reduced value care. Hospitals have recognized the need for high-value care interventions to curb defensive medicine, with some success in managing antibiotics and discharge planning. However, the incentives for such changes remain asymmetric, as hospitals do not bear the same personal risk as individual clinicians ordering tests. Defensive medicine is deeply ingrained in medical culture, shaped by human nature and the inherent risks physicians face. While we lack a clear solution, we hope that raising awareness in medical education can better prepare students and trainees to distinguish between evidence-based and liability-driven decisions.",
  "summary": "(MedPage Today) -- A 12-year-old boy arrives in the pediatric emergency department wincing with right lower quadrant pain. The team quickly gets his vitals, draws blood, and gets a bedside abdominal ultrasound. He has what is expected: uncomplicated...",
  "key_points": [],
  "editors_take": null,
  "illustration": null,
  "coverage": {
    "outlets": 1,
    "also_reported_by": []
  },
  "ai_generated": true,
  "disclaimer": "Summaries, key points and the editor’s take are written by software from other outlets’ reporting and may contain errors — always check the linked original."
}