Defensive medicine

One of my patients, a man plagued by health anxiety, carries with him a folder—worn, bulging and meticulously organized. Inside are doctors’ notes from every country he’s visited. My notes are in there, too.During a recent visit, he pulled out one from his home country. It was for the same complaint I had just assessed. I glanced at it—six lines: a diagnosis, a brief plan and something else we’ve quietly lost in our system—trust.Later that day, I looked at the note I had written for him. Twenty eight lines long. Detailed, precise, worded like a legal document. I remember thinking: how did we get here?Some might argue the brevity of the other note reflects substandard care. But what if it reflects something else entirely—something we can no longer afford? The absence of fear.We don’t write long notes because we enjoy writing. We write them because we’re afraid. And despite the pages, we still miss the essence of the visit—the sighs between sentences, the uncertainty in a patient’s eyes, the silent parts of medicine that never make it into a chart.Read: Dr. Jabir Jassam: The noise of silenceAnother patient of mine had a similar experience. He was under immense stress and presented to an emergency department abroad with chest pain. A normal ECG. Normal bloodwork. The physician looked him in the eye, linked the pain to anxiety and offered a treatment plan. The patient declined medication and flew back to Canada. The stress remained. So did the chest pain. This time, in our system, he went through the full cascade—repeat ECGs, troponins, a stress test, CTA, all unremarkable. He was sent home with the same diagnosis he received overseas: stress-related chest pain. But here, it came at 10 times the cost and 20 times the documentation.This is not rare. In Western medicine, fear is the architect of our daily practice. Fear of complaints. Fear of litigation. Fear of being misunderstood, misquoted, misrepresented. And so, we practice medicine with our guard up. We over-order, over-document, over-apologize. Not because we don’t care, but because we’ve been taught that being careful is not enough—we must be defensible.Defensive medicine is no longer the exception. It is the script. We do it reflexively, and in doing so, we erode what drew us to this profession in the first place.And here’s the irony: defensive medicine doesn’t even protect us. Research after research shows that patients rarely sue because a test was missed—they sue because they felt dismissed, ignored, humiliated. It’s not a lack of data that triggers lawsuits; it’s a lack of dignity.What protects us is presence. Not paperwork. Not protocols. Presence. Listening. Connection. And the quiet but radical act of being human in the room.In countries where litigation is rare and trust remains intact, you can see the difference. Doctors rely on clinical judgment. They move faster, order and document less, and still most of the time reach the same outcome. They’re not reckless. They’re unburdened. They spend less time covering themselves and more time seeing their patients.Of course, those systems have limitations, too. But fear is not the primary operating principle—and that changes everything.The financial cost of defensive medicine is staggering. But the emotional cost is harder to quantify. It’s the exhaustion you feel after spending more time documenting a visit than actually having one. It’s the creeping suspicion that the chart matters more than the conversation. It’s burnout—not from caring too much, but from having to prove, with every click, that we did.Patients suffer, too. Waitlists stretch. Appointments feel rushed. Vulnerable patients—the ones who need more time, not less—often receive the most fragmented care. The system bends toward efficiency, not empathy.Defensive medicine rewires the physician’s role. It teaches us to be cautious, not curious. It teaches young doctors that safety lies not in connection, but in compliance. And slowly, it drains the soul out of the work.This is not just about reforming the legal system—though that matters. It’s about reclaiming our professional identity.We need to train new doctors to speak plainly, to listen more than they type and to stand beside their patients without trembling. We need to remind ourselves—and each other—that we didn’t enter medicine to protect ourselves.We came here to protect others.But somewhere along the way, fear took the pen from our hand.It’s time we take it back, isn’t it? Dr. Jabir Jassam is a family physician in Ottawa.

Defensive medicine

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