Looming ‘threat’ of defensive medicine

NST: KUALA LUMPUR, Mon: It is frightening to imagine a time when doctors will not perform high-risk surgery due to the possibility of legal action.
But this may not be as far off in Malaysia as one may think with more doctors preferring to be "safe than sorry".
A significant minority of doctors are understood to be watching their backs when it comes to diagnoses, tests and therapeutics — to avoid being sued.
Consultant cardiologist Dr David K.L. Quek said "defensive medicine is a deviation from good medical practice".
"Ultimately, patients would be shortchanged and be on the losing end as doctors may be overly cautious. For example, a doctor may not want to perform risky surgery that a patient needs."
He felt that there was a real possibility of this happening in Malaysia with the landmark decision in February by the Federal Court in the case of Foo Fio Na v Dr Soo Fook Mun and Assunta Hospital.
The judge ruled that the doctor had a duty to explain any and all risks and information concerning any medical decision or therapeutic option no matter how remote they could be.
(Foo underwent unsuccessful surgery which resulted in the loss of use of her limbs).
Dr Quek said the implication of the judgment was that defensive medicine might become the standard practice with doctors unwilling to treat serious diseases for fear of litigation.
He was a speaker at the Association of Private Hospitals of Malaysia (APHM) International Healthcare Conference 2007 at the Kuala Lumpur Convention Centre, which ended yesterday.
"The cost of professional indemnity may escalate and medical experts’ opinions may be more difficult to produce or substantiate to the standards required or acceptable to the courts.
"The cost of health care will escalate, with more back-up tests being performed."
Dr Quek said that if defensive medicine continued, research and experimental therapies would be increasingly difficult to embark upon as specialists might want to avoid risks.
A study among doctors in the United States found that 93 per cent who were in high-risk specialties practised defensive medicine while 43 per cent reported using imaging technology although it was unnecessary. He said that although most local doctors may never experience medico-legal problems, the litigation climate had changed.
"More complaints and cases are being tested for negligence or medical accidents. I would think to the tune of affecting about 500 out of 17,000 doctors per year."
In some cases, patients could be looking for "blood money" or retributive compensation.
"But sometimes, bad things just happen. It is good if every doctor is confident that his or her practice is always safe and conscientiously and dutifully performed ... but unforeseen circumstances do occur," he said.
On the issue of the patient’s consent, Dr Quek said patients had a right to information about their condition and treatment options that were available.
"Before major procedures, patients must be told the possible complications that could occur after the surgery so that there are no surprises particularly since eventualities such as intensive care could be expensive and long-drawn," he said.
Lawyer Darryl Goon said doctors should itemise treatments and risks to minimise legal suits.
They should have a witness present when the patient is signing a consent form and ensure that patients understood them.