Reconciling Risk Management and Medical Ethics: Opportunities and Obstacles
A cartoon in the September 4, 1995, issue of the New Yorker depicts a physician sitting at his desk, speaking to a patient. In a remarkable display of candor ( Kapp, 1993a), the physician is explaining, "I'll want to run a few tests on you, just to cover my ass." Whereas the general readership of that publication probably was amused, my strong guess is that most physicians I know would find that cartoon more sad or maddening than funny.
As the previous chapters illustrate in some depth, defensive medical practice is a subject with substantial ethical, legal, and social policy connotations. In law and policy, as well as medicine, the premier principle ought to be the same: "First, do no harm." Defensive medicine is no laughing matter precisely because, according to many, its various manifestations often result in harm to patients, their families, and others who deserve better. In this final chapter, I modestly explore some potential strategies for repairing the dynamic that too frequently leads from physicians' and other health care providers' fear of negative legal entanglements to the conduct of unethical medical practices that threaten to hurt exactly those vulnerable individuals whom both health care and legal professionals purport to help.