Defensive medicine

Defensive medicine refers to any test, procedure, or treatment ordered by a physician that is not normally considered necessary for the patient’s condition. Physicians usually do this because they are concerned about being sued or because they are worried about their reputation in some way. It might also happen because the patient insists on certain types of care, or because the patient’s family pressures the physician to do everything possible for their loved one. Experts say that defensive medicine adds millions to the cost of healthcare and exposes patients to unnecessary tests and treatments. These tests and treatments themselves could pose extra risks to the patient.

Background

Physicians take a Hippocratic oath to act for the good of their patients, to use good judgment in treating patients, and to do no harm. This has been the standard for medical professionals for centuries, with penalties set for physicians who fail to uphold it dating back to about 2030 BCE or more than 4,000 years ago. There are instances of medical malpractice claims filed against physicians accused of not following standard medical procedures beginning in the nineteenth century in the United States. However, suing a physician because of a bad outcome for the patient was not a common occurrence until around the middle of the twentieth century.

Beginning in the 1960s, lawsuits filed by patients or their families who believed a physician provided substandard care began to increase. Patients dissatisfied with an outcome and those who experienced some form of harm would sue the physician in court to recover damages. Patients who could prove in some way that negligence on the part of the physician led to the injury or complication could recover financial damages. This negligence usually involves either an action by the physician (such as operating on the wrong limb) or an omission (such as failing to identify that a person with severe stomach pains has appendicitis). Over the last part of the twentieth century and early part of the twenty-first century, the trend toward suing physicians increased. As a result, experts say, many physicians have taken to practicing defensive medicine.

Overview

Defensive medicine can take several forms. Physicians can order extra tests or procedures to avoid missing a potential cause of the patient’s condition or to confirm that what the physician thinks is the cause is correct. For example, a patient might come to the doctor with headaches. After talking to the patient and discovering that the headaches occur while the patient works on the computer for hours every day, the physician believes the patient is experiencing eyestrain and needs glasses. However, before sending the patient to the eye doctor, the physician orders a computed tomography (CT) scan just in case the headaches are caused by something more serious, such as a tumor.

Another form of defensive medicine is when the physician avoids ordering or performing a procedure that could be risky even though it will likely help the patient. If the physician does this out of fear of being sued or another personal consequence, it is considered defensive medicine. It could also be considered medical malpractice, depending on the outcome for the patient.

It is also considered defensive medicine when a physician orders any form of care solely because the patient or a family member is pressuring the physician to do so. A very common form of defensive medicine occurs when a physician orders an antibiotic for a child with a viral infection at the insistence of a parent. Viral infections may not respond to antibiotics, so the antibiotic will not help the child; it may, in fact, cause an infection when the antibiotic kills the child’s helpful bacteria. However, physicians frequently prescribe an antibiotic simply to appease the parent.

Studies have shown that up to 75 percent of physicians admit to practicing defensive medicine at some point. According to a 2023 report, defensive medicine was more prevalent in the African region and in lower-middle-income countries. Among medical specialties, anesthesiologists showed the highest prevalence. While fear of being sued is a major reason given for the practice, it is not the only reason. Physicians can and nearly always do purchase medical malpractice insurance to cover the financial cost of being sued. Physicians may wish to avoid the time and difficulties involved in court actions related to suits. They may wish to protect their reputation from being associated with malpractice, even if it is unwarranted. They may see ordering extra tests and procedures as the new standard of care and be concerned that they will not look good in the eyes of their colleagues or patients if they do not order what other doctors are ordering. They may also bow to pressure from patients or family members, or they may simply be afraid of making a mistake and harming a patient inadvertently.

Studies have found that physicians whose patients incur the highest costs for tests and procedures do often have lower rates of malpractice suits. However, there is little indication that their patients have better outcomes. The studies also found that some physicians consistently order more tests than their colleagues even when they do not have patient populations with conditions that would require additional testing.

The prevalence of defensive medicine makes it a significant factor in healthcare costs. Since it is difficult to pinpoint the precise percentages of healthcare procedures that practitioners perform defensively, finding an exact cost for procedures, tests, and medications ordered defensively can also be a challenge. Research estimates from data collected in the 2010s and 2020s indicated that the cost of defensive medicine spans from $46 billion to $300 billion, with most data falling between $50 and $65 billion annually.

This expense increases healthcare costs for everyone since healthcare premiums are often based on the average cost to care for a given population. It also increases taxes to pay for the care of those on public healthcare programs such as Medicare, Medicaid, and the Children’s Health Insurance Program, also known as CHIP. Some experts recommend tort reform to fix this, eliminating the possibility of physicians being sued. Instead, patients who experience harm as a result of medical care would be compensated under a no-fault system that would not require the physician to be deemed responsible for the injury.

Bibliography

Bakalar, Nicholas. “‘Defensive Medicine’ May Lower Malpractice Rates.” New York Times, 4 Nov. 2015, archive.nytimes.com/well.blogs.nytimes.com/2015/11/04/defensive-medicine-may-lower-malpractice-risks. Accessed 2 Apr. 2026.

Bal, Sonny B. “An Introduction to Medical Malpractice in the United States.” Clinical Orthopedics and Related Research, vol. 467, no. 2, Feb. 2009, pp. 339–47.

Eftekhari, Mohammad Hossein, et al. “Exploring Defensive Medicine: Examples, Underlying and Contextual Factors, and Potential Strategies – a Qualitative Study.” BMC Medical Ethics, vol. 24, no. 1, 2023, p. 82, doi:10.1186/s12910-023-00949-2. Accessed 2 Apr. 2026.

Gamble, Molly. “Top 10 Reasons Physicians Practice Defensive Medicine.” Beckers Hospital Review, 5 Dec. 2012, www.beckershospitalreview.com/legal-regulatory-issues/top-10-reasons-physicians-practice-defensive-medicine.html. Accessed 2 Apr. 2026.

Lorenc, Theo, et al. “Defensive Healthcare Practice: Systematic Review of Qualitative Evidence.” BMJ Open, vol. 14, no. 7, 2024, doi:10.1136/bmjopen-2024-085673. Accessed 2 Apr. 2026.

Oliver, Wayne. “Ending Defensive Medicine Is Key to Containing Health Care Costs.” Investor’s Business Daily, 24 Mar. 2017, www.investors.com/politics/commentary/ending-defensive-medicine-is-key-to-containing-health-care-costs. Accessed 2 Apr. 2026.

Pischedda, Gianfranco, et al. “Defensive Medicine through the Lens of the Managerial Perspective: A Literature Review.” BMC Health Services Research, vol. 23, 2023, doi:10.1186/s12913-023-10089-3. Accessed 2 Apr. 2026.

Scherz, Hal, and Wayne Oliver. “Defensive Medicine: A Cure Worse than the Disease.” Forbes, 27 Aug. 2013, www.forbes.com/sites/realspin/2013/08/27/defensive-medicine-a-cure-worse-than-the-disease. Accessed 2 Apr. 2026.

Sekhar, M. Sonal, and N. Vyas. “Defensive Medicine: A Bane to Healthcare.” Annals of Medical and Health Sciences Research, vol. 3, no. 2, Apr.–June 2013, pp. 295–96.

Zheng, Junyao, et al. “Prevalence and Determinants of Defensive Medicine among Physicians: A Systematic Review and Meta-analysis.” International Journal for Quality in Health Care, vol. 35, no. 4, 2023, doi:10.1093/intqhc/mzad096. Accessed 2 Apr. 2026.