In a MedPage Today opinion piece, medical students Henry Diamond-Pott and Manav Midha describe defensive medicine as a "hidden curriculum" that trainees absorb on the wards. They cite a common scenario: a child with uncomplicated appendicitis whose family requests a CT scan, which the team orders even though it will not alter the plan. The authors say the real indication is protection from lawsuits, not patient care.
The students note that defensive medicine takes both positive forms, like extra imaging, and negative forms, like surgeons avoiding operations due to risk scores. They reference a 2014 JAMA Internal Medicine estimate that 28% of orders and 13% of costs at one large medical center were at least partly defensive. This creates a tangible conflict: in a clinical reasoning session, the authors chose "order CT" as the next best step, while the correct answer was "admit for surgery."
Diamond-Pott and Midha acknowledge that such choices are human nature, driven by "anticipated regret," and that unnecessary tests carry real harms: radiation, false positives, incidentalomas, higher bills, and longer emergency department stays. They have seen high-value care initiatives improve antibiotic stewardship, discharge planning, and wait times, but they argue these programs cannot fully counter the asymmetry between hospital incentives and the personal risk borne by individual clinicians. The authors offer no solution, but they stress that students are left unsure whether a decision is evidence-based or liability-based.