Wednesday, July 6, 2011
In this week’s Journal of the American Medical Association, cardiologist Peter Kowey, MD describes a case in which a young athlete sees him for a second opinion after a single episode of presyncope. Despite extensive cardiovascular testing that found no evidence to suggest that this young man had an increased risk of sudden cardiac death, another cardiologist had nonetheless recommended the implantation of a defibrillator. Why the overly aggressive recommendation? Dr. Kowey discovers that his colleague, who had endured a lawsuit about a patient with similar circumstances, was practicing “defensive medicine.” He goes on to observe:
Defensive medicine is pervasive and takes many forms. It extends from ordering too many tests all the way to performing unnecessary surgical procedures. Lung nodules that used to be followed end up in a specimen jar in the pathology laboratory. Subcritical coronary artery lesions are dilated and stented. And the contamination is not just at the individual physician level. Practice guidelines are formulated by colleagues who hear the wolf at the door. In the absence of definitive data, wouldn’t it be logical that recommendations about the frequency of prostate biopsy in patients with abnormal PSAs would be on the more frequent side for safety’s sake? And once those guidelines are published, physicians who ignore them do so at their peril.