Fondazione Zoé

Some judiciary sentences have proposed the return to the problem of defensive medicine.

We should first clarify the difference between passive and active defensive medicine. The first happens when a doctor prescribes an excessive number of lab, radiology or other tests and/or a series of useless or excessive drugs, aiming only to legally protect themselves. The recourse to diagnostic practices or invasive treatments which are not justified is considered part of active defensive medicine.
Passive defensive medicine, on the other hand, consists of avoiding all diagnostic procedures or treatments which may be useful for the patient, but are considered risky. This leads to the doctor proposing an easier, but less effective, pathway. The definition also includes the recourse to excessive and unjustified hospital recovery by doctors who prefer not to have patients with a non life threatening, but demanding, illness treated at home. To conclude: all of these anomalous procedures, even if they do not damage the patient, are the cause of an increase in health costs which it is difficult to control.
I must say that health care providers have, on various levels and for a long time, concentrated on this problem with initiatives which look at both the protection of medical staff and the safety of the patient by giving precise definitions, in hospitals, of diagnostic and treatment pathways for various pathologies.
Moreover, a regional conciliate commission has also been instated to resolve controversies outside court where people claim for damages through civil responsibility. In court, hospitals protect doctors with insurance which covers legal costs in both civil and penal cases excluding gross negligence. This does not cover malpractice but only serious cases of negligence and misconduct.
On a local level, supported by various doctors’ associations, Conciliation Services are being created to protect general practitioners and dentists. These services receive and examine accusations from the public for free.

All of these worthy initiatives do not seem, however, to have the desired effect in reducing the number of cases of defensive medicine. Why is it, we ask ourselves, that despite this protection doctors continue to be fearful, in a climate of suspicion and mistrust, which seems to be continually deteriorating the relationship between doctors and patients which, for better or worse, used to work?

The relationships no longer work because the actors have changed. Doctors have become conscious of their own limits and, after a period of euphoria, they realise they are not able to treat and cure all illnesses despite medicines undeniable progress. Patients, on the other hand, have begun to see themselves as a people who can judge autonomously and are longer subject themselves willingly to the judgment and will of doctors.
The terrible media information which one day describes all possible inefficiencies of the Health Service and the next describes doctors and superheroes able to work all miracles, contributes to the creation of an atmosphere of incomprehension, litigation or, worse, legal arguments increasingly waiting in ambush.
If doctors were able, at every meeting with a patient, to create an atmosphere of trust and collaboration and, through precise and correct information, decide a pathway with the patient, then such medical-legal cases would soon disappear, as would, consequently, cases of defensive medicine. Creating doctors with this ability is the real challenge, as it means a student having a teaching body which is able, from the very beginning, to teach them the real art of being a doctor.
Today all this is not yet happening.



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