Pakistan cannot afford defensive medicine.

the first two-thirds of the 20th century, the most common basis on which malpractice lawsuits were lodged against physicians were allegations that the physicians did something wrong. 1,2 About three decades ago, physicians began to be sued for failing to do something right. 3 This was when defensive medicine came into being as a response to malpractice litigations and now it has become an undeclared standard of care, the cost of which is passed on to the patients. Defensive medicine is practiced when doctors order tests, procedures, or visits, or avoid high-risk patients or procedures, primarily (but not necessarily or solely) to reduce their risk of malpractice liability. 4 While the former is positive defensive medicine (assurance), the latter is negative defensive medicine (avoidance). 5 It is not that defensive clinical practices do not provide any benefit to patients, only that the expected benefits are small relative to their costs. It may not be conscious. Some medical practices may get so entrenched over time that physicians become unaware of how liability concerns initially drove them. Perhaps the key findings of the Jackson Healthcare National U.S. Survey of 2009 may assist in giving a thorough idea. 6 Ninety two percent of the physicians reported practicing rule-out rather than diagnostic medicine out of fear that they will miss a diagnosis. The estimated annual cost of defensive medicine is $650-$850 billion, which means $1 of every $4 spent on healthcare is spent on defensive medicine. Moreover, emergency room and primary care physicians and Obstetricians and Gynaecologists were found most likely to practice it. An 83% of young physicians reported being taught in medical school or residency to avoid lawsuits. Emphasis during training has moved from listening to and examining patients to clicking as many buttons on the computer order set as possible to cover every deadly diagnosis. A major portion i.e. 72% of the respondents felt that defensive medicine negatively impacts patient care. Unnecessary testing can lead to false positive results and hence more invasive tests, making complications more dangerous. Unnecessary admissions have their own risks too, as hospitalization exposes patients to new environment, lack of sleep, relative immobility and the risk of nosocomial infections-often triggering a considerable deterioration in function. The risk of being exposed to unnecessary radiation is another huge concern. A 2006 U.S. study conducted in a Level-1 trauma center 7 has found that blunt trauma patients were exposed to …