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    Threat of legal action leads to 'defensive' medicine

    National report — In today's litigious climate, the threat of lawsuits may be causing dermatologists to overtreat some diseases and undertreat others, experts say.

    Abel Torres, M.D., J.D., explains that to play it safe in cases of suspected skin cancer, many physicians perform biopsies they might otherwise postpone until after trying a therapeutic regimen.

    "Many dermatologists are saying, 'If I'm going to get sued for not doing the biopsy, I might as well do it.' That's defensive medicine," Dr. Torres says.

    However, he says, "It's a double-edged sword." Defensive medicine creates more biopsies to manage, "and if dermatologists don't properly follow up, they can get sued for that."

    Dr. Torres is professor and chairman of dermatology, Loma Linda University School of Medicine, California.

    Additionally, fear of lawsuits over side effects may lead some dermatologists to undertreat dermatologic problems that aren't life-threatening, according to Dr. Torres and Norman Levine, M.D., a Tucson, Ariz., private practitioner and a Dermatology Times adviser.

    "Patients are suffering from their disease, but doctors are not anxious to go out on a limb" legally, Dr. Levine says, to help the patient get better more quickly. An example is when a patient with moderate psoriasis is continually treated topically rather than with more aggressive systemic therapies. "I see that all the time," he says.

    John Jesitus
    John Jesitus is a medical writer based in Westminster, CO.

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