The $30 million strain on the NHS

A recent survey conducted by Pulse magazine has uncovered a troubling trend in general practice: four out of five family doctors are now engaging in defensive medicine , a practice driven by the fear of complaints and legal action.

This approach leads doctors to prescribe medications, order tests, and refer patients to specialists more frequently than medically necessary, often deviating from standard clinical guidelines.

The survey of 836 GPs found that 78% agreed that the threat of complaints had forced them to practice more defensively than they belieeve is best for their patients, while only 9% disagreed.

This cautious behavior, while intended to avoid missing serious conditions, can result in overdiagnosis, increased patient anxiety, and additional strain on the NHS through higher costs and demand for appointments.

Complaints and litigation: a perfect storm

The prevalence of defensive medicine is underscored by the high number of compensation cases handled by NHS Resolution, which manages about 3,000 GP-related claims annually,some worth over £4 million.

Additionally, complaints against family doctors have been rising, as evidenced by data from NHS England and the General Medical Council.

The constant fear of litigation or referral to regulators has made GPs more cautious, but this mindset comes with its own risks.

Defensive medicine and burnout: a vicious cycle

Previous research published in the British Medical Journal found a strong correlation between defensive medicine and burnout, suggesting that doctors who practice defensively experience higher stress levels.

One GP described general practice as a very high-risk environment where the only way to survive is to act defensively and have a low threshold for risk, warning that otherwise something will inevitably come back to bite you.

Patients caught in the middle

Patient advocacy groups acknowledge the difficulty GPs face.

Dennis Reed, director of Silver Voices, which represents elderly patients, expressed sympathy for doctors caught between the pressure to investigate and the risk of litigation.

He noted that patients generally prefer their doctors to play it safe and order additional checkks if there is any concern, as the consequences of missing a diagnosis can be serious.

Reed contrasted this with the past, when GPs often overprescribed to manage patient flow.

Now, patients are more informed about available tests and scans and want access to them.