SUMMARY

Nowadays, the claims and demands of the patients are the main cause of medical defensive procedures and we could assert that the existence itself of this defensive medicine would perish if such demands had not place. And that is precisely the hazardous boomerang effect of this defensive medical practice.

Through the last years, the claims of presumptuous mistake, imprudence, negligence or harms consequent to medical care against physicians are increasing to such an extent in Spain that, though not reaching the USA and other Anglosaxon countries levels, are leading to a growth of the sensitiveness regarding the medical profession.

Undoubtedly, the current medical practice is getting more specialized day by day, thus implying liability engaged diagnostic and therapeutic procedures that, attached to a series of factors, like a well-being society that goes through fast and intense technological and scientific changes, foster the belief that as far as the technical reach is greater, the results get better too. But, the medical profession of the XXIth century is enduring a critical moment that must face assuming unprecedented challenges to accomplish not only the change of the expectations but also the new public and political requisites regarding the quality, safety and expense control.

In this context, the physicians meet more difficulties to carry out their job and the sound physician-patient relationship that keeps on stemming, mainly, from the mutual confidence, gets distorted till it leads to conflict situations that nobody would have imagined. New phenomena, like the violent episodes against physicians in their working place or the medical presence in the media, not always offering the profession’s best image are rising. And, given this situation, new claims and demands are filed day after day. Many times, these end up in complaints or demands against the medical practitioner, the medical centre or the healthcare administration in the Spanish courts.

The growth of complaints within the medical field conditions the medical actions towards the safest options and, sometimes, it leads to the over-ordering of diagnostic tests and unnecessary referrals that obviously belong to the so called “defensive medicine”.

In the United States, the practice of the “Defensive Medicine” is related to the phenomenon known as “Malpractice Crisis”, that has been object of an intense and controversial debate on the convenience of reforming the legal system of the MPR given the deep crisis that affects the malpractice insurance market. The dramatic increase of the demands, coincident with a noticeable increase of the compensations cost levels for harms, have rebounded in the price of the insurance premiums of the physicians to such an extent that, in some states where no legislative reforms have taken place, these amounts count more than two digits while in some high liability specialties have become completely unaffordable.

The physician, in the course of his/her professional practice, can be asked another kind of responsibility, understanding the MPR as the obligation engaged by the physicians of repairing and satisfying the consequences derived from their actions, omissions and mistakes, voluntary an even non-voluntary within certain boundaries, committed during the practice of his/her profession. It is mandatory for the Medicine and not the Law to state the general criteria of “good practice” at each moment.

In this article, the types of medical responsibility regarding the Spanish set of laws are exposed; the aim is to describe the context and activities that are thought to be defensive medicine practices and finally, analyze the crisis situation that affects the MPR systems in other countries, specially the USA, while showing what the vast majority of scientists agree with, that is, the impact of these procedures on the daily medical practice. At last, some endorsements aimed at preventing claims and acting accordingly to the normopraxis, are exposed.