Defensive Medicine and Diagnostic Testing
Open accessAbstract
Defensive medicine often involves the excessive ordering of diagnostic tests. Constantly aware of the risk of malpractice liability, physicians turn to diagnostic tests with the goal of reducing the likelihood of error. Findings reported in literature suggest that medical malpractice contributes significantly to the increased use of diagnostic testing and related costs. It has also been demonstrated that defensive testing not only increases costs but harms patients to a degree that depends on the risk incurred by the test itself, its false-positive and false-negative rates, the benefits and risks of available therapies, and the prior probability of disease. Several solutions have been proposed in the attempt to address this issue, but the physician’s competence and training appear to be key factors, data from clinical trials showing that education and feedback for improving test-ordering tendencies have a prolonged effect. Particularly in the field of laboratory medicine, increasing attention is being paid to improving demand management in order to minimize inappropriate testing.
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Clinicians' decision making can be greatly impacted by the potential medical liability risk, which often leads to selecting defensive practices, such as ordering unnecessary tests and referrals, that are perceived as mitigating malpractice claim risk instead of clinically necessary actions to avoid legal issues.
“Clinicians’ decision making can be greatly impacted by the potential medical liability risk, which often leads to selecting defensive practices, such as ordering unnecessary tests and referrals, that are perceived as mitigating malpractice claim risk instead of clinically necessary actions to avoid legal issues [262,263,264].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [262]
The Introduction (page not available in our copy) says fear of liability drives excessive diagnostic testing and reports that physicians often order more tests than medically indicated. The paper does not establish that liability concerns also lead clinicians to make unnecessary referrals, so that example is unsupported. (LLM, conf=0.86)
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References 24 · Cited by 21
Research works printed but not linked: 20
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- Authors
- Plebani, M.
- Affiliations
- Azienda Ospedale - Università Padova (IT)
- Corresponding author
- Plebani, Mario
- ORCID
- Plebani, Mario
- Venue
- Diagnosis
- Publisher
- Walter de Gruyter GmbH
- Published
- 2014-04-12
- Volume
- 1
- Issue
- 2
- Pages
- 151-154
- ISSN
- 2194-8011 (ISSN-L)
- 2194-802X
- OpenAlex
- W1994022449
- Cited by
- 21
- References
- 24
- Citations by year
- 2026: 3 · 2025: 2 · 2024: 2 · 2023: 1 · 2021: 3 · 2020: 2 · 2019: 3 · 2017: 3 · 2016: 1 · 2015: 1
- FWCI
- 3.02
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Diagnosis (publishedVersion, cc-by-nc-nd)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Health Sciences › Health Professions › Pharmacy › Medical Malpractice and Liability Issues
- Health Sciences › Medicine › Physiology › Clinical Laboratory Practices and Quality Control
- Keywords
- defensive medicine, diagnostic testing, medical malpractice liability, overuse of diagnostic tests, health care costs, patient harm, false positive and false negative rates, physician competence, demand management, clinical pathology
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