Patient safety assurance in the age of defensive medicine: a review

Abstract

The definition of defensive medicine has evolved over time given various permutations and combinations. The underlying meaning, however, has persisted in its relevance towards two classifications, positive and negative defensive medicine. Positive defensive medicine is specific to overutilization, excessive testing, over-diagnosing, and overtreatment. Negative defensive medicine, on the contrary, is specific to avoiding, referring, or transferring high risk patients. Given the above bifurcation, the present research analyzes defensive medicine in the landscape of medical errors. In its specificity to medical errors, we consider the cognitive taxonomies of medical errors contextual to execution and evaluation slips and mistakes. We, thereafter, illustrate how the above taxonomy interclasps with five classifications of medical errors. These classifications are those that involve medical errors of operative, drug-related, diagnostic, procedure-related, and other types. This analytical review illustrates the nodular frameworks of defensive medicine. As furtherance of our analysis, this review deciphers the above nodular interconnectedness to these error taxonomies in a cascading stepwise sequential manner. This paper was designed to elaborate and to stress repeatedly that practicing defensive medicine entails onerous implications to physicians, administrators, the healthcare system, and to patients. Practicing defensive medicine, thereby, is far from adhering to those optimal healthcare practices that support quality of care metrics/milestones, and patient safety measures. As an independent standalone concept, defensive medicine is observed to align with the taxonomies of medical errors based on this paper’s diagrammatic and analytical inference.

Homoeopathy: A solution for fibroadenoma

“…Giantsize ranges from 3 to 5 cm and above. [2] Epidemiology They are common in black and Negroes. In 30% of cases they may reduce in size (or) disappear in 2-4 years.…”

“…Some minute yellow to pink softer areas are also seen [5] Clinical features Painless, slow growing, lump in lower part of breast [5] . Smooth with round border firm to hard in consistency and freely mobile [2] . It is known as 'breast mouse' as it moves freely in the breast [6] .…”

“…They are mostly unilateral but in 20% of cases, they are multiple and bilateral also. Size varies from 1cm-3cm and above [2] . Generally, Fibroadenoma will not turn into malignancy [3] .…”

Delayed intestinal obstruction from an unintentionally retained surgical gauze in a 24-year old woman two years after caesarean section: a case report

“…Forgetting a foreign body such as a mass of cotton material, sponges’ gauze, towels, or even instruments is one of the worst misadventures that a surgeon could ever have, which comes with several legal and social consequences [ 1 ] [ 2 ]. For this condition, the term gossypiboma (derived from Gossypium for “cotton” and Boma for “a place of concealment”) is commonly used [ 3 ].…”