“Defensive Medicine” Topic of CVMC’s March ‘Conversations in Ethics’ March 14, 2008 Catawba Valley Medical Center invites healthcare professionals and the community to attend the next ‘Conversations in Ethics’ to be held from 12 noon to 1 p.m. Thursday, March 20 in the Northwest AHEC Lecture Hall, Room 112. This monthly, no-charge meeting provides an opportunity for discussion of some of the most important issues facing the healthcare profession today. The discussion topic for March is “Defensive Medicine.” Mr. Green has presented himself at the emergency department (ED) of the local hospital with indigestion, chest pain, nausea and vomiting. He is afraid that he is having a heart attack. Dr. Brown, the attending ED physician, is attentive and caring. He is aware that Mr. Green is a somewhat anxious patient requiring a great deal of assurance in order to remain calm. During his assessment, Dr. Brown learns that Mr. Green is self-employed and doesn’t have health insurance. He makes a moderately successful living and has just recently saved enough money for a down payment on his dream home. After a thorough examination, Dr. Brown rules out acute heart condition. He believes that the symptoms are more than likely due to gastric problems. Of course, few things, if any, in medicine are absolutely certain and a complete battery of expensive tests would provide a more definitive diagnosis, as well as help put the patient more at ease. Dr. Brown knows that these tests are expensive and will most likely cost Mr. Green his dream home down payment. Dr. Brown also knows that these tests could possibly protect him if Mr. Green should choose to sue him. While he is confident in his diagnosis, he is tempted to order the battery of tests not to protect Mr. Green’s health but to protect his reputation and career and avoid a possible lawsuit. Mr. Green arrived at the ED believing that the physician would make decisions based on what was best for him, the patient. He is not aware that doctors at times must practice “defensive medicine.” He will, of course, accept the best medical judgment of the physician. Possible questions for discussion include: What should Dr. Brown do? Has Dr. Brown made a mistake in talking to Mr. Green about his personal life including his insurance coverage or lack of it, his dreams and ability to pay? Should Dr. Brown order all possibly relevant tests in order to protect his career and/or the hospital? Should a physician (or a hospital) have to choose between the best interest of the patient and the best interest of the physician? Many medical testsand procedures are not risk-free. What if Dr. Brown believes that one or more of the tests, in addition to being costly, may also put the patient at some risk for complications? Should he order them anyway? Would you want them ordered for you? A free lunch will be served to those who register no later than Tuesday, March 18 by calling 828-326-3365. Catawba Valley Medical Center’s Department of Organizational Learning is an approved provider of continuing nursing education by the North Carolina Nurses Association, an accredited approver by the American Nurses Credentialing Center’s Commission on Accreditation. Completion of this activity provides 1.0 contact hour. Catawba Valley Medical Center is a not-for-profit, public healthcare system providing and promoting the physical, mental, emotional and spiritual well-being of the public in addition to serving as a center for health education, wellness services, preventative medicine and acute care. CVMC, recognized by the American Nurses Credentialing Center as a Magnet facility, was recently named a Hospital of Choice by the American Alliance of Healthcare Providers.