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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.

Prevention of photoaging-associated changes in facial contour may be another benefit of sunscreen use, according to study findings presented by researchers from the Skin Research Center at Johnson & Johnson Consumer Companies, Skillman, N.J., at the 2011 meeting of the Society for Investigative Dermatology.

Researchers have made important progress toward understanding mechanisms of melanoma-acquired resistance to BRAF inhibitors that has led to the identification of combinatorial molecular targets, the inhibition of which could potentially restore therapeutic efficacy.

Based on steady progress in laboratory studies, researchers are optimistic about the potential for noninvasive terahertz imaging systems to become a useful tool for intraoperative delineation of nonmelanoma skin cancers (NMSCs).

Potential problems that can arise with electronic health record (EHR) implementations range from technical difficulties to legal wrangling over responsibility for the necessary hardware, software and data, say two dermatologists and a lawyer.

Psoriasis is a stronger predictor of elevated cholesterol in children than is body weight, according to an analysis of electronic medical records from Kaiser Permanente Southern California (KPSC). The findings reinforce the need for physicians to address the condition as a systemic metabolic disorder rather than as a superficial skin disease.