The Silent Epidemic: How Defensive Medicine Creates Cancer Patients
The most dangerous moment in modern healthcare isn't when doctors make mistakes—it's when they're afraid to.
I still remember her face.
Sixteen years old. Nausea and vomiting for 24 hours. No fever. No abdominal tenderness on exam. Clear signs of the viral gastroenteritis sweeping through her high school.
"This looks like the stomach bug going around," I told her and her anxious parents. "Fluids, anti-nausea medication and rest at home should resolve this within a day or two."
As I handed over the discharge papers, the nurse looked at me and said, "you know Dr. X missed appendicitis in a teenager last week. Same symptoms. No tenderness. Kid came back septic."
She didn't need to say more. I understood the subtext immediately.
Our monthly department meeting was still fresh in my mind—the medical director reviewing our "quality metrics" with a frown.
Length of stay was up. Number of patients seen per hour was down. And there was that case presentation about the missed appendicitis, with our leadership team in the back of the room taking notes.
The hospital’s stance was clear: When in doubt, scan. Protect the hospital. Protect yourself.
I changed the order from "discharge" to "CT abdomen with contrast."
Not because she needed it. Not because evidence supported it. Not because it would improve her outcome in any meaningful way.
I ordered it because the culture demanded it. Because the system prioritizes legal protection over patient welfare. Because a missed diagnosis would haunt my career while an unnecessary CT was just "thorough medicine."
Happens every single day.
And now, a bombshell study confirms our worst fears about this practice.
The Cancer-Causing Reality of Defensive Medicine
A groundbreaking study published this month, in JAMA Internal Medicine has revealed the staggering cost of our defensive medical culture.
Researchers at UCSF analyzed 93 million CT scans performed in 2023 and estimated they will cause approximately 103,000 future cancer cases. This places CT scans on par with alcohol consumption and obesity as major cancer risk factors in the United States, potentially accounting for 5% of all cancer diagnoses.
Let that sink in.
The medical procedures we order to protect ourselves are creating healthcare’s future customers.
From years of practice in the ER, this hits particularly close to home. We order a disproportionate number of these scans, often in low-risk scenarios where the legal risk outweighs the medical benefit.
The Invisible Pressure
The average person has no idea what happens behind the scenes in an emergency department.
Every decision I make exists within a complex web of competing interests:
Legal liability: Miss a subarachnoid hemorrhage in that headache patient? Your career might be over.
Administrative metrics: Hospitals track your "door-to-disposition" times. Quick scans speed up decisions.
Patient expectations: Try telling a worried parent you won't scan their child's head after a minor fall.
Consultant demands: Many specialists won't see patients without imaging first.
Financial incentives: Hospitals bill thousands for each CT. The machines must be kept running.
None of these factors prioritize the patient's long-term health - especially the invisible cancer risk from radiation exposure.
The Most Vulnerable Pay the Highest Price
Perhaps the most disturbing finding from the UCSF study is who faces the greatest risk.
Infants undergoing CT scans had a 10-fold higher cancer risk compared to other age groups. Children and adolescents followed closely behind.
Yet in emergency departments across America, CT scans are routinely ordered for minor head injuries, abdominal pain, and other conditions that could be managed with observation or alternative approaches.
Why? Because missing a rare but serious diagnosis in a child is the fastest way to end a medical career.
The Broken System That Forces Bad Medicine
Understanding why this happens requires examining the perverse incentives baked into our healthcare system:
Malpractice law rewards defensive practice: Courts don't punish doctors for unnecessary tests, only for missed diagnoses.
Insurance reimburses testing, not thinking: A thoughtful clinical assessment pays a fraction of what a CT scan does.
Patients equate more testing with better care: We've trained the public to expect scans for every complaint.
Hospital administrators evaluate clinicians on metrics, not outcomes: Patient satisfaction and door-to-disposition times are valued more than restraint.
The false security of documentation: Ordering tests creates a paper trail showing you "did everything possible."
This system doesn't just waste resources- it actively harms patients while pretending to protect them.
The Way Forward
If we're going to address this crisis, we need fundamental changes:
For Policymakers:
Create "safe harbor" legal protections for physicians who follow evidence-based guidelines
Reform malpractice laws to recognize that unnecessary testing causes harm
Fund research into non-radiation alternatives and AI-assisted clinical decision support
For Hospital Systems:
Stop encouraging bad practices
Reward appropriate restraint in test ordering
Create peer review systems that don't punish missed diagnoses when the right process was followed
For Clinicians:
Have honest conversations with patients about radiation risks
Push back against consultant demands for unnecessary imaging
Use validated clinical decision tools to support imaging decisions
For Patients:
Ask "Do I really need this test?"
Request the lowest radiation dose possible when scans are necessary
Understand that more testing doesn't always mean better care
The Courage to Change
Every day in the emergency department, clinicians are forced to choose between protecting patients and protecting themselves.
That's not medicine. That's bureaucracy and madness.
The UCSF study should serve as a wake-up call. We've built a system where doctors routinely expose patients to cancer risk to avoid lawsuits and meet metrics.
The greatest irony? Most clinicians know this is happening. We discuss it in break rooms. We feel the moral injury. We recognize the harm we're causing.
But changing requires something more than awareness. It requires courage- the courage to practice medicine based on evidence rather than fear.
I don't have all the answers.
But I know that continuing on our current path means creating more cancer patients in the name of defensive medicine.
And that's a diagnosis none of us should accept.
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Until next time,
Tiffany
This article represents personal views and experiences and is not medical advice.
There are always trade offs. The important thing is to recognize them, make them clear, and help individuals decide what is best for them based on their unique situation given the costs and benefits. Standard of care ruins this possibility by forcing clinicians to practice according to a "one size fits all" and defensively to avoid liability. Both of which, of course, ignore individual patient needs in favor of unrelated interests.
Scans are a scary trade-off, that almost sound like a revenue raiser in the USA.
Unfair and costly to patients.
Potentially deadly to patients.
Coercive to GPs and specialists.
Contrary to the old rest and recover, come back and see me next week, we will wait and see how it goes approach of 40 years ago.
The relationship between cancer and scans seems a bit like the unnecessary increase in caesarean births, so there's no damage to the woman's vagina.
Booking in for a caesarean means they can miss going through the extreme pain of a full labour in a more natural vaginal birth, in what male partners often view as a wrecking ball to a women's pleasure garden.
It seems to me there's a lot of unnecessary procedures and tests in treatment today, excluding immunisation.
I honestly believe that immunisation is the single most beneficial health intervention in the past 80 years. Saving the world from measles, mumps, rubella, whooping cough, TB, and the impairment of polio has been brilliant. Vaccinations have also prevented millions of deaths from Covid, pneumonia, influenza, shingles, and other harmful disorders.
Let's hope Trump and lower sidekick Kennedy don't slam the breaks on vaccines in the crazy cost cutting, Making American Billionaires Even Richer Project 2025 disasters as well.
That would take the health of all Americans back 60 years on health.