Ask any physician who has been sued for medical malpractice how their behavior changed as a result of the lawsuit. Most go on defense, ordering more tests, explaining and documenting all risks no matter how remote or irrelevant they are, or avoiding difficult patients. This is called “defensive medicine,” a process undertaken “to avoid liability rather than to benefit the patient.” Defensive medicine increases the cost of healthcare and also exposes patients to added risk due to the unnecessary tests and procedures themselves.
Medicine is similar to gambling in being an exercise in uncertainty, with odds and probabilities replacing certainty and predictability. One patient may visit their cardiologist, be given a clean bill of health, then drop dead of a heart attack walking from the doctor’s office to their car. Another patient with untreatable metastatic cancer is suddenly in remission and cancer free. Physicians process myriad bits of data, coupled with their observations, and years of experience, in the end making an educated guess as to what’s wrong and how to treat it. Usually right, but occasionally wrong, virtually all doctors want what is best for their patients and will do their best to deliver.
Compare medicine to law enforcement. Police work also involves probabilities. Is a threatening individual approaching a police officer planning on yelling, hitting, or shooting? Are they armed? Knife or gun? Are they rational, drunk, or high? Just like in the emergency room, things happen quickly. Judgments must be made in seconds based on incomplete or conflicting information. Again, it’s all probabilities, but not certainties. As any sports gambler knows, the long shot occasionally wins.
Doctors and cops will occasionally make the wrong decision. Not because they are bad people. Not due to racism or sexism. But simply because they are human and imperfect. When things go wrong, people can be hurt or even die. It might be only in hindsight that the decision appears wrong but when the scenario is replayed, with the same initial facts, most colleagues would have made the same decision.
Physicians are punished through malpractice lawsuits. The annual risk of getting sued varies from 3 to 19 percent based on specialty. The emotional and financial consequences of a lawsuit are high. Even worse for police. Aside from losing their jobs, they can be indicted, as six Baltimore police officers were in conjunction with the death of Freddie Gray who died while in police custody. Or face death threats to their families, as McKinney Texas Officer Eric Casebolt is facing following the recent pool party episode.
Are these police officers guilty of police malpractice? The accusation alone is enough to ruin their lives. The Baltimore cops face a trial with the associated emotional and financial costs. The McKinney cop may face the same if the district attorney has an axe to grind or aspires to higher political office. Maybe they deviated from the “standard of care” or maybe they didn’t. Ferguson, Missouri police officer Darren Wilson was castigated for months after shooting Michael Brown, until the facts revealed “hands up don’t shoot” was one big lie.
Cops, like doctors, go on the defensive, each group practicing their own version of “defensive medicine.” Just as physicians can avoid complicated patients, police can do the same. Looking the other way, responding slowly, not giving a ticket or making an arrest are all ways of avoiding risk. Arrests in Baltimore are down 50 percent after the 6 officers were indicted. Last month was the deadliest month for Baltimore in 15 years. Coincidence or police going AWOL?
Not only Baltimore but also New York City where arrests are dropping. Mayor de Blasio threw New York cops under the bus after the Eric Garner affair, where Mr. Garner died during his arrest in Staten Island. Another coincidence or police going on defense?
Ask the cops themselves. A Baltimore police officer admitted, “I think the public really, really sees that they asked for a softer, less aggressive police department, and we have given them that” In other words, if the cops are the bad guys and well intentioned police work leads to public castigation or criminal charges, then this should be no surprise.
The prevalence of smart phones with instant video doesn’t help matters. Sure it’s good to record events, but video can be edited or incomplete. Not only by bystanders but also by news organizations. NBC altered the George Zimmerman 911 call to cast portray Zimmerman as a racist. When cameras come out the cops may just keep walking, ignoring the reason for their visit. Patients may also want to video their office visit with their doctor, which, aside from privacy issues, “could exacerbate physicians’ temptation to practice defensive medicine.”
Both physicians and police officers work in a world of rapidly unfolding events, incomplete or conflicting information, and the need for quick decisions, which however well intentioned, may in hindsight be wrong. When politicians make wrong decisions, for example authorizing a war, they get reelected or promoted to Secretary of State. Not so for doctors and cops who may face professional and personal ruin. Physicians have long figured this out and practice defensive medicine. While a new concept for police, we are starting to see the same effect across the county. And when the police are really needed they won’t be there. Call Al Sharpton instead.
Brian C Joondeph, MD, MPS, a Denver based physician and writer. Twitter @retinaldoctor.