Defensive Medicine = Doctors Protecting Themselves

They are being forced to manage patients very guardedly, but this is hardly an ideal equation

- Anoop Misra

When I returned from the US two decades back a friend told me, “You should learn to drive again in India. Use ‘defensive driving’ so as to protect yourself on Indian roads where people may damage your car, or even kill you.” I did not know that nearly 20 years later, the term ‘defensive medicine’ would be apt for Indian physicians, where physicians need to protect themselves from disrepute and physical harm.

There are numerous instances of attacks on doctors, nurses, and other healthcare workers, who are usually defenseless and remain soft targets. Some of the doctors have been labelled as “killer doctors”, “murderers” etc. Mostly, these doctors did their best to save the patient, working at odd times in stressful conditions and with poor infrastructure. Some work for 24-36 hours at a stretch diligently to serve sick patients. Overall all physicians stick to the basic oath, “First do no harm.”

Diagnoses shaped by new threat perceptions

But episodes of violence and hate continue to occur. In this vitiated atmosphere, many doctors have changed the way they practise medicine. Gone are the days when a pulse was taken, chest and heart were listened to, a few tests were ordered and diagnosis was made. Now algorithms for diagnosis and management take threat perception from a patient’s relatives into account. Here are some examples to illustrate my point.