Home > Medical School, Medical/Health Commentary > Defensive Medicine 101… it starts now

Defensive Medicine 101… it starts now

Over the past few years I’ve seen many exhortations (such as this one) to be aware of the “hidden/shadow/unofficial/cultural curriculum” of medical school. The “hidden curriculum” is that part of training that imbues us freshly-minted medical students with the often-unspoken values, norms, stereotypes (surgeon jokes, anyone?), and attitudes common to the profession.  Most often, this “hidden curriculum” is said to be imparted unintentionally by professors and clinical role models.

Sometimes, however, there’s nothing hidden or unintentional about it.

Our recently-started anatomy class actually begins with a couple of weeks of embryology.  Here’s one of the questions from the textbook, and its answer.  To be fair, the question itself wasn’t assigned, but rather the chapter in which it was located.

Question:  “A 22-year-old woman who complained of a severe “chest cold” was sent for a radiograph of her thorax.  Is it advisable to examine a healthy female’s chest radiographically during the last week of her menstrual cycle?  Are birth defects likely to develop in her conceptus if she happens to be pregnant?”

Answer:  “Yes, a chest radiograph could be taken because the patient’s uterus and ovaries are not directly in the x-ray beam.  The only radiation that the ovaries receive would be a negligible, scattered amount.  Furthermore, this small amount of radiation would be highly unlikely to damage the products of conception if the patient happened to be pregnant.  Most physicians, however, would defer the radiographic examination of the thorax if at all possible, because if the woman had an abnormal child, she might sue the physician, claiming that the x-rays produced the abnormality.  A jury may not accept the scientific evidence of the nonteratogenicity [doesn’t cause birth defects –NWS] of low-dose radiation.” [emphasis added]

There you have it.  Our first explicit lesson in defensive medicine before we even get near the cadavers in anatomy class.  Some things you just can’t make up.


I hear the answer to that question in the next edition will include a helpful reminder to make sure to run the radiograph order by the patient’s insurer’s radiology management service first.


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