Medicina defensivaaspectos sociales, éticos y jurídicos

Abstract

Defensive medicine, which emerged in the United States as a physician´s deviation from what is considered to be good practice in response to the increase in medical malpractice lawsuits in the 1960s, it is currently a global problem and an element of a low-value health care. In any case, the challenge begins in its definition. Objective: An accurate definition is required both by epistemological and ethical reasons. Furthermore, it is necessary to establish a theoretical framework and fulfil a systematic approach to defensive medicine. Methodology: Review of the scientific literature. Narrative integration of the results and analysis of this complex problem from an interdisciplinary approach, being the rights-based approach to the clinical relation the most valuable one. Results: The lack of a single definition of defensive medicine hinders the empirical research. The diversity of elements increases tolerated abuses which finally distort clinical practice. To overcome inconveniences, the relational perspective offers a comprehensive approach based on 1) trust, understood as a need and a human value that guide decision-making and promotes reasonable and wise clinical responses, and 2) recognition and reciprocal respect between patients and healthcare professionals for avoiding conflicts. In the end, four basic defining elements are identified: subject, object, motivation, and purpose.