I’ve been thinking a lot lately about the Standard of Care, and how it’s slowly morphed from a clinical floor into a legal ceiling.
Last shift, I found myself ordering a CT for a patient where my clinical gut (and the evidence) said it was 99% unnecessary. I didn't do it because I thought it would change my management, I did it because I couldn't stomach the 1% chance of a deposition three years from now asking why I didn't order it.
We talk about Evidence-Based Medicine, but in practice, it feels like we’re actually practicing Litigation-Based Medicine. It’s creating this bizarre feedback loop: 1. We order defensive tests to avoid lawsuits. 2. Those tests become the new normal for that presentation. 3.The legal Standard of Care shifts to require those tests. 4. Costs skyrocket, and clinical intuition is treated like a liability rather than a skill.
At what point does our safety net start causing more cumulative harm (radiation, incidentalomas leading to invasive biopsies, financial toxicity) than the rare misses it's meant to catch?
Is there a way back from this, or are we just destined to be highly-trained checklist fillers for the insurance and legal industries?