Defensive Medicine Is in the Eye of the Beholder

Today I was on the lookout for a cost-saving topic to write about, on the heels of my blog debut last night.  Sometimes life delivers inspiration, and then adds an exclamation point.

One of my morning appointments involved a nice man complaining of recent heartburn.  An OTC medication provided him complete relief, but the package recommended that he consult a doctor before taking it for more than two weeks.

“Can I stay on it?” he asked.

Doing my job to be cautious, I peppered him with numerous questions and found him to be the poster child for uncomplicated, run-of-the-mill heartburn.  He had absolutely no risk factors or warning signs for a more sinister problem.  I easily see a half-dozen people like him each and every week.

I explained that the intent of the package warning is to keep people from masking the symptoms of a more serious condition, thinking that everything is okay.

Only a tiny number of people with uncomplicated heartburn turn out to have cancer, I told him, with most primary care physicians only seeing a handful of cases in their entire career.  I still offered to arrange a barium swallow or endoscopy to be extra careful, but he decided not to undergo further testing unless the medication proved inadequate, or he developed worsening symptoms.

Knowing that defensive medicine is a hot topic, I decided during my lunch break that this man’s situation provided a perfect example.  Although the term “defensive medicine” implies a physician ordering tests only to avoid a lawsuit, more often the intent is simply to be thorough in providing the best care.

It can be challenging to decide when prudent evaluation becomes unnecessary expense.

Although extreme caution might dictate that cancer be assumed until disproven, I knew that this man’s situation would almost certainly turn out well.  If I were to order expensive and unpleasant tests for every case of heartburn, I would likely be accused of practicing defensive medicine, rather than applauded for rendering exceptional care.

Having decided upon the topic for my article, I returned to my afternoon work.

During a slow moment I decided to catch up on the growing pile of mail received.

Among the various lab results and letters from consultants was a pathology report for another man whom I take care of.  The diagnosis was adenocarcinoma (cancer) of the stomach.

I now wonder if I should approach tomorrow’s heartburn sufferer any differently than I did today?

Stephen Meyers, MD


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