Guest Post by Mike Pringle (a nursing supervisor) of the Mike's Viewpoint blog

An article in the Washington Post reports out on a survey conducted between November 2003 and June 2004 contrasting physicians’ beliefs about medical errors and incompetence reporting compared with what they really do when they know of a colleague who is not maintaining standards. The survey which was printed in the Annals of Internal Medicine incorporated 1600 physician responses which noted about 45 percent didn’t always report an incompetent or impaired colleague -- even though 96 percent agreed that doctors should turn in such people.

Chris Lee who authored the article describes how many providers are unwilling to provide negative feedback about other peers when asked questions by their patients regarding who is and who is not a “good doctor”. The article also describes how some physicians order expensive diagnostic tests for patients even though there isn’t any reasonable medical indication for such testing. The work up is done at the request of the patient. Other tests are ordered as a defensive measure mainly in hopes to stave off any future litigation.

Primum non nocere, -- do no harm, widely believed to come from the Hippocratic Oath but in fact this dictum actually comes from the Hippocratic Corpus, at least in essence. Noble words to guide ones practice of medicine for sure. Providing high quality healthcare is no easy task and in today’s world, it is expensive. For each measure of medicine that we practice there is an equally sized dose of law that most healthcare providers and institutions are practicing as well. Trying to cover all the bases with expensive diagnostic work ups, or ordering test just because your patient who comes to the emergency department and is insistent on having an MRI for chronic low back pain are common place.

Healthcare is not a drive up window for prescription medications and diagnostic workups. It is certainly not an opportunity for gaining financial freedom as is the lottery when your provider makes an honest mistake and a bad outcome prevails.

Defensive medicine is much more costly and time consuming and doesn’t demonstrate the appropriate use of precious resources. The focus needs to be on higher professional standards and doing the right thing for the patient.