Defensive Medicine---“The Devil Made Me Do It!”

If unnecessary tests and procedures are major reasons for the high cost of health care in our country shouldn’t we make an effort to identify the doctors engaging in such practices and take steps that will cause them to stop?

We are not doing that. In fact, no effort is being made to identify the culprit doctors. And for those who publicly claim they are in the practice of ordering unnecessary tests or know of fellow doctors who do so, nothing is being done to reprimand, sanction, or even criticize them by either the American Medical Association or State medical societies. Instead, commentators and our legislators accept whole cloth the doctors’ claims that they are being forced to engage in such practices because of the “fear of being sued” and express sympathy for their “plight”.

The excuse that is being given for the practice is nothing other than the “The Devil Made Me Do It” defense. It’s what you said when your hand got caught in the cookie jar - your Mother didn’t buy it and your hand was slapped - we shouldn’t buy it either. Those in the medical profession who are engaged in ordering unnecessary tests should be given a dose of tough love with their hands slapped instead of a “there there” and a hug.

It’s more than an unnecessary expense that is making health care costs in our country soar. Ordering tests that are not necessary is blatantly unethical and dangerous.

Let’s take the most commonly cited example of “unnecessary tests” that are being ordered in our country----radiology studies such as X-rays and CT scans. These are not innocuous studies. X-rays and CT scans can have major adverse health consequences such as cancer for the patients who are being x-rayed and scanned. A recent study has concluded that as much as two percent of cancer cases diagnosed in our country are likely related to cumulative over-exposure to radiation.

We all absorb a small level of radiation in our daily lives from a variety of sources such as radon, which exists in the soil and emits low levels of radiation, but the major single source of our exposure to radation during our lifetimes is from radiology imaging studies such as X-Rays and CT scans. A CT scan exposes a patient to an estimated 1,000 millirems of radiation per study. Exposure to 2,000 millirems of radiation in the course of one’s lifetime is considered “high". After two CT scans a patient has been exposed to a high dose of radiation! That’s the serious consequence to the patient if his doctor knowingly orders an unnecessary CT scan. For more information on the study referenced above go to the following link: http://www.washingtonpost.com/wp-dyn/content/article/2009/10/05/AR2009100502908.html)

All doctors take the Hippocratic Oath. It is an oath which traces its origins to the early days of medicine in the fifth century BCE. It is a sacred vow to “do no harm” in administering to a patient’s medical needs. The Code of Medical Ethics of the American Medical Association incorporates this same ethical principal by stating “A physician shall be dedicated to providing competent medical care, with compassion and respect for human dignity and rights.”

For a doctor to order tests that he knows are unnecessary flies in the face of the Hippocratic Oath, violates the Medical Ethics sanctioned by
the AMA and rubs raw because it is placing his or her vaguely threatened self interest above the best interests of his patient.

The “devil made me do it” is no defense to this unethical and dangerous practice. Doctors take an oath-they should abide by it.