Urologists often on the 'defensive' when ordering tests


Urology Times asks five urologists about diagnostic tests and practicing 'defensive' medicine.

A survey by Northwestern University in Chicago of its medical students showed that 94% have witnessed medicine being practiced defensively. Northwestern says the survey suggests that although defensive medicine isn't an official part of the curriculum, it is being "taught" to medical students.

Urology Times wanted to know urologists' outlook on defensive medicine. Do urologists practice it? How does it affect patient care? And what is its impact on the health care system? The consensus: Just about all physicians do it, and the result is higher costs.

"I think all doctors practice defensive medicine," he said. "The main impact of practicing defensively is that it adds an additional layer of costs. If you order tests that you probably wouldn't ordinarily do and don't think are necessary on the small chance that you might have missed something, it adds an additional layer of costs.

"Whether or not it improves patient care is a tough question," said Dr. Hyacinth, who is director of service, department of urology at Kings County Hospital, and has been in private practice 15 years. "It might not in a private practice, but in a city hospital there's a big push for patient safety guidelines. There is significantly more redundancy with the patient prior to taking someone to the operating room. Hospitals are investing a lot of money in this, so I guess they concluded that it does improve patient care and reduces their exposure.

"Some fundamental things do need to take place prior to going to the OR, but adding all these layers of redundancy may actually cause more errors in documentation, and slows down the process."

"You do your job, try to deliver the best patient care, do the right thing, and, hopefully, you won't have a problem," he said.

"If you practice defensively, it may drive up the cost of medicine. If I think something could be even a remote problem, I will probably order the test just to make sure I have confirmation that at the time I saw the patient, he did not have a cancer.

"If I'm not 100% certain, or if I think a problem could come back to haunt me 3 years from now, I'll order the test."

Director of research and clinical trials and a founder of the Urology Center of Colorado, Dr. Karsh says those decisions can backfire. "On one hand, the committee asks, 'Why did you do that test?' The other committee asks, 'Why didn't you do that test?' "

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