The “NUTS” statistic: Applying an EBM disease model to defensive medicine

Abstract

Physicians believe that malpractice concerns result in unnecessary testing, and many emergency physicians state that avoiding malpractice is a contributing factor to ordering medically unnecessary tests. Unfortunately, defensive medicine does not come without possible harm to patients who may be subject to non-beneficial, downstream testing, procedures, and hospitalizations. We submit a novel statistic, "NUTS" or "Number of Unnecessary Tests to avoid one Suit. " We calculated a NUTS of 4737 for troponin testing in ED patients with suspected myocardial infarction, meaning a clinician will need to order 4737 medically unnecessary troponin tests to avoid one missed myocardial infarction lawsuit. The NUTS framework offers us an evidence-based lens to examine defensive medicine less superstitiously and more based on currently available data.

Reconsidering evidence-based management of endometriosis

“…In addition, we did not discuss other limitations of EBM and the hierarchy of evidence, such as publication bias ( Vercellini, 2014 ; DeVito and Goldacre 2019 ), procedural aspects such as financial bias in funding ( Howick, 2019 ) and drug research ( Klemperer, 2010 ), the epistemological discussion to distinguish justified belief from opinions ( Gaeta and Gentile, 2016 ) and the importance of medicolegal aspects as described in the recent introduction of NUTS (Number of Unnecessary Tests to avoid one Suit) statistics ( Allen et al, 2021 ).…”

Hierarchy of evidence for endometriosis diagnosis and surgery.

“…These considerations explain the ongoing discussions on the hierarchy of evidence (35), procedural aspects such as financial bias in funding (36) and drug research (37), and the epistemological discussion to distinguish justified belief from opinions (38). Also, medicolegal aspects influence clinical judgment as evidenced by the recent introduction of NUTS (Number of Unnecessary Tests to avoid one Suit) statistics (39). Clinical experience and judgment somehow integrate the entire population with rare cases and multimorbidity with case reports and the vast literature of descriptive observations, influencing our judgement.…”