Defensive medicine in the emergency department. The clinicians' perspective

The overuse of medical services is regarded as a growing problem in Western countries, accounting for up to 30% of all delivered care, and carrying a higher risk of morbidity and mortality. One of the leading drivers toward medical overuse is the so-called defensive medicine, which is commonly defined as ordering of tests, procedures, and visits, or, at variance, avoidance of high-risk patients or procedures, aimed to reduce exposure to malpractice liability. Defensive medicine may increase the amount of care provided to the patients (i.e., additional tests or therapies), change care or setting of care (i.e., patients referred to another specialist or another healthcare facility), or impair the optimal care (i.e., refusing risky patients). Some studies seem to confirm a large utilization of defensive medicine in the emergency departments. This article tries to analyze some key points capable to pave the way to a consistent reduction of defensive medicine, thus defining a hierarchical list of priorities, keeping the patient's health always at the center of the matter.