It was nearly midnight at a paediatric A&E department in a busy Midlands hospital. 

When concerned parents brought their sick child in, the consultant was on continuous duty for 9 hours.

It was the first time that the child hadn’t been fed in 24 hours. The baby also had a rash. 

The doctor was exhausted after having to make a series of decisions about life and death, which included one quick resuscitation. He quickly assessed the possibilities for his patient.

Most often, the child will not experience any symptoms that could indicate something serious. These symptoms could mean that the child is experiencing sepsis. This is a potentially life-threatening response to infection.

Margaret Simson (above), 73, from Corstorphine, Edinburgh, ended up in intensive care and spent two years with a stoma bag after an 'unnecessary' colonoscopy procedure to investigate chronic bowel symptoms

Margaret Simson, 73-year-old Margaret from Corstorphine in Edinburgh ended up in intensive medical care. She spent 2 years on a stomabag after having an “unnecessary” colonoscopy to examine chronic bowel symptoms.

Medics admit that defensive medicine is rife, thanks to the ever-rising tide of complaints and clinical negligence claims against the NHS. Defensive medicine is when doctors carry out a test or procedure or offer treatment that may not be warranted, simply in order to avoid the remote possibility of a complaint or legal action should the patient be unhappy. (File image)

Medical professionals admit to defensive medicine being rampant due to the growing number of clinical negligence cases against the NHS and the rising tide of complaints. When doctors perform a procedure, test or provide treatment that is not warranted to the patient in an attempt to minimize the possibility of legal action or complaints. (File photo)

‘It was midnight, I hadn’t eaten or drunk anything or had a break – I worried about whether I could make the right decision,’ the doctor says.

“I remembered recent high-profile cases that involved doctors being prosecuted because they did it wrong. Talking to a colleague, I realized no one would appreciate us doing nothing.

The consultant, who asked not to be named, admitted the child for blood tests and a lumbar puncture – an invasive procedure which involves using a needle to extract fluid from the spine to look for signs of infection.

Sometimes it will need to be done more than one time. Complications, while rare, can include nerve damage and headaches, as well as bleeding. 

But the parents seemed happy to hear that their worst fears were being addressed.

He is doing well and should be able to recover. But this well-respected senior doctor has been left with doubts over whether their decision – this happened just last week – was truly necessary.

“In cold daylight, the next day you will think: “Why did that?” I would have changed my mind if it was at the start of each shift.


Are doctors willing to give their patients treatment they do not need because it is possible for them to be sued? 

Listen to the Medical Minefield Podcast and hear one woman’s story about how defense medicine has left her in such dire straits. Click here. 

It’s an astonishing confession: a healthcare professional candidly revealing that a patient was subjected to needless tests and investigations, driven, at least in part, by fear – not just the fear of missing something vital for the sake of the patient but the fear of being sued for it.

This isn’t a rare or unusual case. Due to an ever increasing number of clinical negligence and complaints about the NHS, doctors acknowledge that defensive medicine is rampant.

The broad definition of defensive medicine covers a wide range of circumstances. 

It’s the practice of offering treatment or a test that might not be necessary, in an effort to minimize the risk of patient complaints or any legal actions. 

Sometimes the patient may demand something that isn’t necessary and the doctor agrees. It could also be that the doctor is too eager to perform treatment or conduct overzealous research, such as the one described.

A study revealed that 87.5 percentage of doctors had practiced defense medicine at some point.

Invasive biopsies performed on benign lumps or growths. Stents are sometimes not recommended for patients with mild heart disease.

Tissue scans and X-rays are used to diagnose common headaches. Over-prescription of antibiotics and over-ordering blood tests. 

The Mail’s Medical Minefield Podcast featured Dr Jenny Vaughan (neurologist), who said that it was a’major problem’.

She stated that there isn’t a part of the NHS where the long tentacles and defensive medicine can’t reach.

These come with significant financial expenses.

However, what is the harm in having a few additional tests done or using pills to ensure your safety?

Patients must be aware that there are risks associated with certain procedures and tests.

Margaret Simson is a good example. After an “unnecessary” colonoscopy to examine chronic bowel symptoms, the 73-year old from Corstorphine in Edinburgh ended up in intensive medical care.

In one study, 87.5% of doctors admitted that they'd practised defensive medicine of some kind. Invasive biopsies carried out on harmless lumps and growths. Patients with mild heart disease undergoing stent operations that may not benefit them at all. X-rays and CT scans (file image) being carried out for common headaches and bad backs. Antibiotics over-prescribed and blood tests over-ordered

A study revealed that nearly 87.5% said they had practiced defense medicine. Invasive biopsy performed on benign growths and lumps. Stents may be unnecessary for mild cases of heart disease. File image: X-rays/CT scans are taken for common headaches. Blood tests ordered and antibiotics prescribed too often

Margaret, who runs a holiday park, had been referred twice previously for the same procedure after experiencing bowel urgency – and both times she had been told that there were no signs of anything sinister.

A colonoscopy – a camera on a thin tube used to check inside the bowel – is the main tool used to diagnose bowel cancer, and about 650,000 are carried out in the UK every year.

However, the demand is increasing for these instruments, even though there’s a slight risk of them puncturing the delicate tissue in the bowel. This can be a serious condition that could lead to death.

A stool and blood test are usually offered first to patients. Margaret wasn’t referred in 2018

According to her, it was the worst decision of her entire life. After three weeks of intensive care, she developed sepsis.

Today, life remains difficult. She says, “I regret being in the operating chair.”

I’ve experienced many difficulties. Although they tried to figure out why I was having problems, it became clear that this was not necessary. It was not even troubling.

These figures are very stark and support the trend towards defensive medicine. A report by the Academy of Medical Royal Colleges in 2014 found that £2.3 billion a year was wasted by the NHS on unnecessary tests and procedures.

Professor Sir Bruce Keogh, in a report for NHS England in 2015, highlighted how dramatic the impact can be for patients – for example, one woman in seven has a ‘needless’ hysterectomy. 

For everything, from cancer and fibroids to abnormal tissue growth conditions, womb surgery can be offered. In the former case the operation might serve as an emergency over more involved options.

Recent high-profile criminal cases 'make doctors paranoid', according to Prof Roger Kirby, president of the Royal College of Medicine. He points to the case of trainee paediatrician Hadiza Bawa-Garba (above), who was convicted of manslaughter after six-year-old Jack Adcock died of sepsis that she had mistakenly diagnosed as gastroenteritis. Bawa-Garba has had her licence to practise restored – but the case proves doctors today risk being criminalised for their mistakes

Roger Kirby of Royal College of Medicine says that recent high-profile criminal cases have’made doctors paranoid. Hadiza Bawa–Garba, a trainee paediatrician was convicted for manslaughter in the death of Jack Adcock (6 years old). She had misdiagnosed her sepsis as gastroenteritis. Bawa-Garba has had her licence to practise restored – but the case proves doctors today risk being criminalised for their mistakes

Other times, routine checks may reveal small lesions or lumps that were not present in the past. Once they are discovered, doctors may feel the need to operate.

Undoubtedly influencing doctors’ decision-making are the rising clinical negligence claims against the NHS, which cost about £8billion a year – half in legal fees alone.

Roger Kirby of The Royal College of Medicine says recent high-profile criminal cases “make doctors paranoid”. 

He cites Hadiza Bawa–Garba as an example of a trainee paediatrician who died from sepsis after Jack Adcock, six years old, was misdiagnosed with gastroenteritis.

  • The number of written complaints received by the NHS fell from 113,000 in 2019 and 84,000 in 2020 during the pandemic.
  • Clinical negligence All claims Maternity services Make up 2/3 Check out all the legal cases Against NHS

After a patient died from a perforated colon, David Sellu, a surgeon was sentenced to prison. 

Sellu later had his conviction quashed, and Bawa-Garba has had her licence to practise restored – but these cases prove doctors today risk being criminalised for their mistakes.

Professor Kirby stated that doctors are trying to keep away from being referred to the General Medical Council and prosecution. The goal is to reach retirement and avoid being referred by the GMC.

Fear of being sanctioned isn’t the only reason. He adds that doctors will carry the guilt and shame they feel following a misdiagnose or mistake for a lifetime. 

The reality is that patients will usually be happy to have their concerns and fears addressed by a doctor.

Patients’ wants – as opposed to needs – are partly responsible for driving the trend, doctors say.

‘It’s the society we live in – people are not so deferential to doctors and there’s a lot of false information on the internet, as well as information which is educating people about their health but which also becomes difficult to digest,’ Prof Kirby adds.

“The end result is that patients complain when they don’t receive what they want. Let’s take the case of a patient with a bumpy breast. It is almost always benign. If it were to happen, the person would have reassured you that they could still get a normal lumpy breast. 

This might be a problem for patients as they may feel like you aren’t taking their concerns seriously. Today, you might add “Just so we are on the safe side” to your patients. 

‘But mammograms use X-rays, and these can actually raise the risk of cancer – it’s a tiny risk, but a reason not to give the scan without good medical justification.

Minna Johansson is a Swedish GP and the director of Cochrane Sustainable Healthcare. She wrote last year about defensive medicine. 

She stated that doctors who fail to diagnose are often resentful and even punished. However, those who overdiagnose and treat patients aren’t. 

The figures which underpin the defensive medicine trend are stark. A report by the Academy of Medical Royal Colleges in 2014 found that £2.3 billion a year was wasted by the NHS on unnecessary tests and procedures

It is not hard to see the figures that underpin defensive medicine. A report by the Academy of Medical Royal Colleges in 2014 found that £2.3 billion a year was wasted by the NHS on unnecessary tests and procedures

“Much too rarely do we think about the possible harm to our patients from those investigations that we perform ‘just incase’.

Elle added that she believed it was safe to do an investigation and learn more.

Radiation can cause harm. A biopsy can result in a bleeding. Finding a benign abnormality in your brain when having a scan to needlessly investigate something else can cause massive harm – people have died from surgery to remove it, when it may never have caused a problem.

“As societies, we don’t know how to deal with uncertainty.”

This is an example of common cardiology procedure. 

Research shows that statins and beta blockers are the most effective ways to prevent a heart attack from occurring when scans reveal blocked blood vessels. 

Despite this, a surgical procedure to insert a stent – a metal cylinder which holds open the artery walls – is often given.

Unidentified cardiologist stated that when you discover a blockage in the heart, you have to worry.

“Even though there is no evidence to support the idea that stents can cause more damage than good, inserting one feels like it’s doing something.

One in fifty people who have a stent will suffer serious complications such as heart attacks or strokes.

A procedure called knee arthroscopy that uses keyhole surgery to repair and treat damaged and painful joints in the knee has been deemed ‘overused and ineffective’ and potentially dangerous. There is no advantage over placebo surgery. Yet, the UK still performs 150,000 procedures each year.

It is possible that the pandemic made matters worse.

Patients are less likely to see GPs in person, so it is tempting for them to offer referrals for more detailed investigations.

Prof Kirby stated that these figures have ‘undoubtedly’ increased the six-million people who are currently waiting on hospitals’ lists and to the “swamped” urgent cancer pathway.

A 18-year old girl reported to her GP that she had been diagnosed with breast cancer and was referred for urgent treatment.

Despite her being unlikely to develop malignancy, she refused to go to the doctor and referred her.

A mother who was also a GP stated that the doctor is wasting a precious appointment. It’s a waste of a valuable appointment.

Dr Johansson said that the pandemic was also a chance to shift away from defense medicine.

She says, “We moved from talking too much to considering the benefits and risks again.” Hospitals are dangerous and should not be used lightly.

These are some of the lessons she believes we can learn from them.

Another doctor posted on Twitter, “We must do the right thing for the right people. Not everything for everybody.”

Is the Pandemic over? How do we obtain the Covid Pill?

I’ve heard the UK has a pill to fight Covid – who will get it?

Tuesday saw the UK become the first country in the world to allow the Covid antiviral drug. Molnupiravir is a Covid antiviral drug that was tested in US clinical trials. It has shown measurable reductions in hospitalizations of up to 50%. 

A trial showed that the pills were most effective when taken two times daily.

UK regulators suggest that you give molnupiravir as soon as possible after your positive Covid test and no later than five days from the onset of symptoms.

However, it will not be extended to anyone but the most severely ill. It is available to people who are over 60 years old, have heart conditions, diabetes or obesity.

It is not clear how the drugs will be distributed by NHS. 

There have only been 480,000 Covid pills purchased. This means there are approximately 40,000 Covid cases per day. The supply will not last winter.

There may also be additional antiviral medicines in development. 

Pfizer, which makes the antiviral pills, announced Friday that it had reduced hospitalisations and even death rates by 89%. UK already has ordered over 250,000 courses.

What is the expected peak in Covid cases?

Experts believe that Covid infection may have reached a peak and will soon be declining rapidly. 

On Friday, Office for National Statistics released its most recent Covid-19 infection survey. This showed that in England, about 1 in 50 people have been infected by the virus in the seven-day period.

Importantly, this survey revealed that infection rates in children were on the decline. Experts predict that infections will continue falling in children if this trend continues.

Director of Rosalind Franklin Institute Professor Jim Naismith said that the prevalence among teens is trending downward from its high level. These teens had high levels of infection, which was driving the rise in case numbers.

Scientists argue it’s too soon to determine the impact of the vaccine booster campaign. However, many scientists believe that this effect will occur within weeks.

Paul Hunter from the University of East Anglia said that the numbers offered some reassurance that Covid infection in England might have reached its peak.