The practice of “Defensive Medicine”

The practice of “Defensive Medicine” grows alongside the rise of medical malpractice claims.

The number of medical malpractice claims in South Africa is rising at an alarming rate, and along with this trend is the potential increase in the practice of defensive medicine.

Defensive medicine happens when doctors depart from normal medical practice in order to safeguard themselves from litigation."It occurs when a medical practitioner performs treatment or procedures to avoid exposure to malpractice litigation.” The dangers of defensive medicine include increased health care costs and pose risks to the patient. The relationship between the doctor and patient may be compromised as well.

There may be valid reasons for wanting to practice defensive medicine, such as patients (or family members of patients) insisting that everything humanly possible be done to help the patient, or the desire to attain a standard of perfection to which patients hold physicians. But the most common reason for the practice is the fear of malpractice lawsuits, and the resultant loss of financial stability and loss of reputation that comes with it.

Defensive medicine can take many forms, for example avoiding procedures that could help a patient but that are deemed risky, or ordering unnecessary tests, prescribing unnecessary medication and needless hospitalisation.

A Gallup and Jackson Healthcare study from 2010 found that private sector doctors practice defensive medicine more often than public sector doctors.

The shift in mind set from benefitting the patient to avoiding litigation does not bode well for the health care system and quality of care may be compromised.

While ordering an unnecessary test may seem prudent, invasive testing may pose its own risks that patients may otherwise have avoided if the test were not done.

“Defensive medicine is not just expensive and wasteful. It could increase your risk of litigation if practices result in harm.”

An American study of radiologists who performed mammograms found that the fear and experience of a malpractice suit caused great stress and almost a third of the radiologists studied had considered withdrawing from mammogram interpretation because of malpractice concerns. Over half of those radiologists indicated that their concern increased the number of their recommendations for breast biopsies. Other studies have shown that over diagnosis and overtreatment of patients following a routine mammogram may lead to more harm than benefit for patients who are asymptomatic and at average risk of breast cancer.

Doctors have to be thorough, but operating from a place of fear is not good. Partnering with the right team is useful in mitigating risk. The Natmed team, with our wealth of experience in the medical malpractice, insurance and health care industries, can help. An informed approach to risk management and ensuring that health care practitioners have adequate medical malpractice coverage go some way toward avoiding the excessive practice of defensive medicine. Proper communication with patients, a deep knowledge of how to obtain informed consent and thorough patient contracts could also help. Speak to us for more information on how to best manage your risk and avoid some of the stress that a medical malpractice claim brings.


Aneesa Bodiat
Head Of Legal
Natmed Medical Defence (Pty) Ltd
First published August 2018