Medical Students Describe Hidden Curriculum of Defensive Medicine

Two medical students describe how defensive medicine is routinely practiced during clinical rotations, often without formal instruction. They recount a pediatric appendicitis case where a CT scan was ordered mainly to protect against potential litigation rather than to change management. The piece argues this hidden curriculum creates tension with evidence-based training and affects costs and care.

Two medical students recount a 12-year-old with straightforward appendicitis. Although bedside ultrasound made the diagnosis and surgery was scheduled, the team still ordered an abdominal CT after parental concern. The scan did not change treatment, but the family later faced a bill of several thousand dollars.

They trace defensive medicine to the 1970s malpractice crisis. A 2014 JAMA Internal Medicine study cited in their essay found that at one large medical center, 28% of orders and 13% of costs had at least some defensive motivation. They also describe positive and negative forms, plus a hidden curriculum that can conflict with evidence-based algorithms.