The risks of defensive (emergency) medicine. The laboratory perspective

Diagnostic testing is a crucial aspect of the clinical decision making, especially in emergency settings where timely and accurate diagnoses are essential for appropriate patient management. Reliable statistics attest that the vast majority of clinical decisions for diagnosis, treatment and follow-up of both acute and chronic diseases are influenced by results of laboratory analyses. As specifically concerns the emergency department, many unnecessary laboratory tests are also ordered in this healthcare setting, with unfavorable consequences on laboratory and healthcare organization. As far as the laboratory environment is concerned, defensive (emergency medicine) may be associated with incremental costs, derangement of laboratory organization, enhanced complexity of data management process, diagnostic delay attributable to performance of unnecessary testing, and litigation. Educative or even regulatory interventions are hence urgently needed to addresses problems of the current liability system, in order to decrease the detrimental effects of defensive (emergency) medicine in the laboratory.