The Rise of Defensive Medicine Among GPs
A growing concern among general practitioners (GPs) in the UK is the increasing prevalence of "defensive medicine" as a response to the threat of complaints. A recent survey reveals that four out of five GPs have adopted this approach, which involves practices that may lead to over-diagnosis and unnecessary medical interventions.
This trend has been driven by fears of legal action or being reported to regulatory bodies if a serious condition is missed. As a result, many GPs are more inclined to prescribe certain medications, refer patients to specialists, or spend additional time on patient notes to protect themselves from potential backlash.
Impact on Patient Care and the Healthcare System
While these measures are intended to minimize risk, they often deviate from standard medical practice. This can involve prescribing extra drugs, ordering more tests, and creating unnecessary anxiety for patients. Additionally, it places an added burden on the healthcare system in terms of costs and demand for appointments.
According to the survey conducted by Pulse, 78% of GPs agreed that the threat of complaints had led them to practice more defensively than they believe is best for their patients. Only 9% disagreed, highlighting a widespread concern within the profession.
One GP shared their experience:
"I have found myself practising more defensive medicine at times, perhaps investigating or referring where previously I might have watched and waited. Despite time constraints, I find myself writing essays in patient notes to make sure I’ve covered my own back, safety-netted clearly."
"This, combined with patient attitudes, has made working in the NHS almost untenable in the current climate."
Legal and Regulatory Challenges
The issue is not just theoretical. Figures from NHS Resolution, which handles compensation claims on behalf of the health service, show that around 3,000 cases involving GPs are dealt with each year, some worth over £4 million. Meanwhile, data from NHS England and the General Medical Council also indicate a rise in complaints about family doctors and their care.
One doctor described general practice as a “very high-risk environment” and stated that the only way to navigate it is to act defensively and maintain a low threshold for risk. “Otherwise, almost certainly something will come back to bite you,” they added.
Link Between Defensive Medicine and Burnout
Research published in the British Medical Journal has shown a strong link between defensive medicine and burnout among doctors. Those engaged in such practices are more likely to experience stress and exhaustion.
Dennis Reed, director of Silver Voices, which advocates for elderly patients, acknowledged the challenges faced by GPs. “I do feel sorry for GPs in this regard as they do risk a frenzy of litigation if they miss something. It seems they are damned for sending people for tests and damned if they don’t.”
“However, I think most patients would rather see their doctor play it safe and send them for additional checks if they have any concerns – it’s best to cover all angles as the consequences of not acting could be serious. In the past, there was a tendency for GPs to overreach for their prescription pad and dole out drugs just to get patients out the door. Now, patients know there are so many tests and scans available, they want to access them – and I can understand why.”
Broader Implications and Support
The survey findings are part of a new report on complaints and regulation, produced by Cogora, the publisher of Pulse, and funded by Medical Protection, which provides indemnity services to GPs.
Dr Sarah Townley, deputy medical director at Medical Protection, emphasized the growing pressure on GPs. “We know our members feel a growing sense of pressure. They're worried about all sorts of medicolegal issues – complaints, claims, even police investigations – it's definitely at the back of their minds.”
She noted that multiple factors contribute to defensive medicine, including fear of consequences linked to complaints, regulatory actions, or patient dissatisfaction. “The wider culture where doctors feel they're being publicly criticised may also be a factor.”
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