Defensive medicine now is part of training

I found your article on tort reform (“Tort Reform,” August 10, 2013) among the best I have read in your publication. There are important elements not considered in the article that your readers may want to consider. First, defensive medicine is being taught in all training centers throughout the United States, thereby assuring that graduates of training programs arrive in practice with a defensive mind-set.

I spent 27 years in an academic career before entering private practice 9 years ago and observed first-hand the evolution of the teaching of defensive medicine. I also see it in the practice patterns of recent graduates of clinical training programs. Thus, if the defensive approach to training young physicians were to be abandoned today, there would still be an entire generation of physicians who have been trained to practice defensively.

Second, defensive medicine has become the standard of practice in the vast majority of communities. Who will reset this standard, especially in light of the above-mentioned training of physicians? The outcome of most malpractice suits is determined by whether or not the physician involved had adhered to the standard of practice. As long as the standard in the community is defensive medicine, the epidemic of litigation will continue.

These two issues are obviously interrelated, but solving them will require a long period of time and a change in the incentives that drive the practice of medicine that you so nicely addressed in your article.

Marc D. Thames, MD

Phoenix, Arizona