Defensive medicine: A symptom of uncertainty?. (August 2022)

• Record Type: Journal Article
• Authors: Finucane, Laura M.; Greenhalgh, Susan M.; Mercer, Christopher; Selfe, James
• Is Part Of: Musculoskeletal science and practice. Volume 60(2022)
• Publication Date: 2022-08
• Subjects: Defensive medicine -- Clinical reasoning -- Serious pathology; Manipulation (Therapeutics) -- Periodicals; Physical therapy -- Periodicals; Neuromuscular diseases -- Treatment -- Periodicals; Musculoskeletal system -- Diseases -- Periodicals; Manipulation (Therapeutics); Neuromuscular diseases -- Treatment; Physical therapy; Manipulation, Orthopedic; Musculoskeletal Diseases -- therapy; Neuromuscular Diseases -- therapy; Physical Therapy Modalities; Electronic journals; Periodicals; 615.82
• DOI: 10.1016/j.msksp.2022.102558
• Languages: English
• ISSNs: 2468-8630

Abstract

Abstract: Defensive medicine is a well-documented phenomenon and refers to the practice of over-cautious management of patients, leading to excessive clinical activity such as over–investigation, unnecessary appointments and additional interventions. Adopting this approach is not in the best interest of patients and can lead to clinical reasoning being replaced by lists, guidelines and algorithms which do not consider the complexity of a patients presentation or the reasoning inherent in good clinical judgement. The drivers of defensive medicine are varied and include a high level of uncertainty alongside other factors including clinical experience with past cases, system pressures and patient expectations. This paper explores these drivers and considers strategies on how best to avoid a defensive medicine approach. It reinforces the need to adopt a patient centred focus and use sound clinical reasoning to support the management of patients. Highlights: Defensive medicine is used to try to prevent complaints or criticism. With advanced roles defensive medicine may challenge good practice in physiotherapy. Unnecessary investigations are costly and may not allay patient fears. A defensive medicine approach should be avoided when faced with uncertainty. Sound clinical reasoning underpins best practice.