Intended for healthcare professionals


Does defensive medicine protect doctors against malpractice claims?

BMJ 2015; 351 doi: (Published 04 November 2015) Cite this as: BMJ 2015;351:h5786
  1. Tara F Bishop, assistant professor,
  2. Michael Pesko, assistant professor
  1. 1Division of Health Policy and Economics, Department of Healthcare Policy and Research, Weill Cornell Medical College, New York, NY
  1. Correspondence to: T F Bishop tlfernan{at}

It’s too early to say, although there seems to be a link between higher healthcare spending and lower risk

In a linked paper in this issue, Jena and colleagues (doi:10.1136/bmj.h5516) examine a longstanding, unanswered question about the US malpractice system: if doctors spend more, will they reduce their risk of being sued?1 This is an important question that explores the contentious issues of defensive medicine and the risk of malpractice claims in the US healthcare system.

Defensive medicine refers to medical care performed primarily to reduce the risk of litigation. Positive defensive medicine occurs when doctors perform more tests or procedures than are necessary. Negative defensive medicine occurs when doctors avoid high risk procedures or refuse to care for high risk patients. Most doctors in the United States state that they practise defensive medicine, and it is estimated that $60b (£39b; €54b) is spent annually on defensive medicine.2 3 Although the US is considered a highly litigious environment, clinicians in other countries also report practising defensively.4

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