Lawrence Shombert, MD
Peninsula Regional Medical Center, Salisbury, MD
I don't know that we order tests for defensive medicine, but whenever there is a doubt, you don't take the risk. If you really believe your risk of being sued was a whole lot less you might err on the side of clinical judgment.
With all the debate about tort reform I don't know if the answer is that simple. It is definitely a move in the right direction. But even if you changed it tomorrow, physicians are still going to have the mentality of being careful. Some doctors are extremely cautious because they want to do the right thing, rather than to just protect themselves. I don't think we do anything that is unnecessary; we just do maybe more studies than we have to in order to be sure of our clinical decisions.
You can complain all you want about unnecessary studies, but if you can't protect the physicians, you can't change it. Doctors can justify a study clinically because any good plaintiff's lawyer is going to justify it clinically. "Couldn't you have ordered that test, doctor?"
You can't come down on radiologists because all they are doing is a study that has been requested by another physician. It is not their decision to say clinically whether it is warranted or unwarranted. They bear the brunt of "You guys are overusing the machine." Nonsense! We were asked. We can't tell you what is a valid request and what is not.