Unconscious defensive medicine: The case of erythrocyte sedimentation rate

Asher, Elad; Parag, Yoav; Zeller, Lior; Yerushalmi, Ronit; Reuveni, Haim

doi:10.1016/j.ejim.2006.07.021

« Previous Next »European Journal of Internal Medicine
Volume 18, Issue 1 , Pages 35-38, January 2007

Unconscious defensive medicine: The case of erythrocyte sedimentation rate

Elad Asher
- Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva, 84105 Israel
- Tel-Aviv Medical Center, Department of Internal Medicine E, Tel-Aviv, 64239 Israel
- Corresponding author. Soroka University Medical Center, PO Box 151, Beer-Sheva 84101 Israel. Tel: +972 8 640 3405.
Yoav Parag
- Tel-Aviv Medical Center, Department of Internal Medicine E, Tel-Aviv, 64239 Israel
Lior Zeller
- Soroka University Medical Center, Internal Medicine D, PO Box 151, Beer-Sheva, 84101 Israel
Ronit Yerushalmi
- Soroka University Medical Center, Hematology Department, PO Box 151, Beer-Sheva, 84101 Israel
Haim Reuveni
- Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 653, Beer-Sheva, 84105 Israel
- Soroka University Medical Center, Pediatrics Division, PO Box 151, Beer-Sheva, 84101 Israel

Received 20 November 2005; received in revised form 26 May 2006; accepted 11 July 2006.

Abstract

Background

We investigated physician rationale for and against performing routine erythrocyte sedimentation rate (ESR) tests during hospital admissions.

Methods

A comparative, descriptive, prospective study among 82 physicians in 15 departments of internal medicine from two University Medical Centers – A and B – in Israel was conducted between July and August 2004. Reasons for physicians’ use of ESR were examined using a confidential questionnaire. A panel of four experts reviewed the need to perform an ESR test in 100 patients’ files from center B. The main outcome measures were the use of ESR in routine hospital admissions and reasons for use.

Results

Forty-four vs. zero physicians from medical centers B and A, respectively, routinely perform ESR tests for all admitted patients (p<0.001). According to the experts, in only 10–30% of the 67 new patients could ESR tests have been of some value. Reasons for performing ESR routinely were as follows: to identify severe and “hidden” diseases (21/44, 47.7%); because it is crucial for all patients, both new and returning (10/44, 22.7%); because it is a guideline from department head (6/44, 13.6%); it is recommended in the literature (5/44, 11.4%); don't know why (2/44, 4.5%); defensive medicine (1/44, 2.3%); and other (6/44, 13.6%).

Conclusion

Routine use of ESR tests on admission can be explained by old habits and by an unconscious concern about liability, i.e., unconscious defensive medicine.

Keywords: Defensive medicine, Routine tests, Unconscious behavior, Liability