潇湘渌水 @ 2010-03-04 23:20
Defensive medicine: the practice of ordering medical tests, procedures, or consultations of doubtful clinical value in order to protect the prescribing physician from malpractice suits. Or is the practice of diagnostic or therapeutic measures conducted primarily not to ensure the health of the patient, but as a safeguard against possible malpractice liability. Fear of litigation has been cited as the driving force behind defensive medicine.
Defensive medicine takes two main forms: assurance behavior and avoidance behavior. Assurance behavior involves the charging of additional, unnecessary services in order to a) reduce adverse outcomes, b) deter patients from filing medical malpractice claims, or c) provide documented evidence that the practitioner is practicing according to the standard of care, so that if, in the future, legal action is initiated, liability can be preempted. Avoidance behavior occurs when providers refuse to participate in high risk procedures or circumstances.
Theoretical arguments based on utilitarianism conclude that defensive medicine is, on average, harmful to patients.
1978年，美国学者Tancredi等提出“防御性医疗行为”（defensive medicine）一词，对于防御性医疗行为的概念学界尚无统一的界定。
“防御性医疗”有两个概念：一个是“积极性防御医疗”assurance behavior，就是医生小心翼翼地为患者做各种各样名目繁多的检测，几套治疗方案，工作周密。即便是积极性防御医疗，也有对患者很不利的一面，尽管它看似更严谨、更周密、更细致。它可能会增加很多无谓的检测的程序、方法、手段，从客观上讲增加了卫生费用，对医疗资源是一种消耗和浪费。
另一个是“消极防御性医疗”avoidance behavior，首先医生考虑避免事故的出现，假如这个患者的病有太大的风险，我可以拒绝为他治疗。如果是一个危重病人，经过抢救他可能还能活过来，但是万一抢救不过来，这个病人在我手里过去了怎么办？一个医生要想拒绝抢救一个病人，他可以找出很多合理性的理由，“我们医院的医疗条件有限，技术能力不够”诸如此类的理由，或者说——“你们赶快转协和（医院）吧”等等
已知防御性医疗行为在美国是高发的，达79-93%，尤其在急诊、产科和其他高风险的专科内。就成因而言，除了前面提到的医疗高风险，还有医疗事故认定采用“举证责任倒置”原则，强化了医方采取防御性医疗行为；还有医患关系的恶化造成信任度低，医疗风险的责任分担和事故保险不健全，甚至还有些医院为避免纠纷而强调的行政压力等等。
