Plebani Mario
1Department of Laboratory Medicine, University-Hospital, Padova, Azienda Ospedaliera di Padova Via Nicolo Giustiniani 2 Padova 35128, Italy.
Diagnosis (Berl). 2014 Jun 1;1(2):151-154. doi: 10.1515/dx-2014-0002.
Defensive medicine often involves the excessive ordering of diagnostic tests. Constantly aware of the risk of malpractice liability, physicians turn to diagnostic tests with the goal of reducing the likelihood of error. Findings reported in literature suggest that medical malpractice contributes significantly to the increased use of diagnostic testing and related costs. It has also been demonstrated that defensive testing not only increases costs but harms patients to a degree that depends on the risk incurred by the test itself, its false-positive and false-negative rates, the benefits and risks of available therapies, and the prior probability of disease. Several solutions have been proposed in the attempt to address this issue, but the physician's competence and training appear to be key factors, data from clinical trials showing that education and feedback for improving test-ordering tendencies have a prolonged effect. Particularly in the field of laboratory medicine, increasing attention is being paid to improving demand management in order to minimize inappropriate testing.
防御性医疗通常涉及过度开具诊断检查。由于始终意识到医疗事故责任风险,医生会借助诊断检查以降低出错的可能性。文献报道的研究结果表明,医疗事故在很大程度上导致了诊断检查使用的增加以及相关成本的上升。此外还证实,防御性检查不仅会增加成本,还会对患者造成伤害,其伤害程度取决于检查本身所带来的风险、假阳性和假阴性率、现有治疗方法的利弊以及疾病的先验概率。为解决这一问题,人们提出了几种解决方案,但医生的能力和培训似乎是关键因素,临床试验数据表明,旨在改善检查开具倾向的教育和反馈具有长效作用。特别是在检验医学领域,人们越来越重视改善需求管理,以尽量减少不适当的检查。