To the Editor: General practitioners increasingly find themselves facing lawsuits for delay in diagnosis. Having personally been asked to be an expert witness in a number of cases, I have perceived a common theme. The cases generally turn on whether a particular investigation such as a computed tomography (CT) scan should have been ordered, based on the clinical presentation.

Even when the doctor “wins”, this hardly compensates for the years of stress defending the case. As more cases are reported, more GPs are inclined to order tests to exclude rare conditions. No one has yet been successfully sued for ordering an “unnecessary” test. The public has been conditioned to regard tests as good and more tests as better. The public has also been conditioned to believe that tests are an entitlement.

From the other side, a recent report by the Professional Services Review (PSR)1 gained media attention for focusing on the “unnecessary” ordering of CT scans. Radiation exposure in these tests is a potential health risk, and their use has increased greatly over the past 20 years.

PSR Director Tony Webber was “alarmed at the number of these scans ordered without clinical justification”.1 It was subsequently reported that there was a drop in the number of scans ordered in the weeks after the report’s release.2

To order tests to satisfy the requirements of Medicare, there needs to be what the Health Insurance Commission regards as “clinical justification”. Yet to not order tests, when clinically there may be no strong grounds other than the exclusion of a rare condition, can lead a GP to face either a lawsuit or a medical board inquiry if a diagnosis is missed.

And herein lies the problem. Clinical grounds are subjective and assessed in real-time, rather than with the benefit of hindsight after hours of poring over every tiny facet of a consultation.

However, there are solutions. Medical boards need to give more weight to clinical judgement than to the ordering of tests. The medical profession needs to admit publicly that, despite 21st century science, the practice of medicine remains imprecise and not everyone can get a perfect outcome every time.

Alternatively, if GPs are to be the protectors of the Medicare dollar and must risk facing legal action to do so, then perhaps Medicare needs to pay the indemnity insurance for those who put their neck on the line when they decline to order tests that the public believes are its entitlement.