Defensive medicine grows where fear rules. Value-based health care grows where judgment, trust, and outcomes matter. That is the clash now facing many doctors. On paper, health systems say they want high-value care, better outcomes, lower waste, and patient-centered decisions. In real life, many doctors practice in an environment shaped by needless complaints, crushing legal defense costs, underfunded services, regulator overreach, and instant reputational damage through online and social media. That mix pushes doctors away from value and toward self-protection.
Defensive medicine is often described as ordering extra tests, referrals, scans, and follow-up visits to reduce legal risk. That definition is too narrow. Defensive medicine also includes avoiding complex patients, overdocumenting every encounter, refusing reasonable clinical flexibility, prescribing or investigating “just in case,” and making choices designed less to help the patient than to survive the next complaint. It is medicine practiced with one eye on the chart and the other on the courtroom, the regulator, or the comment section. That is bad for patients and bad for health systems. Value-based health care asks a different question: What action produces the best outcome for the patient at the lowest necessary cost and burden? It rewards careful thinking, restraint, coordination, prevention, and individualized care. It depends on trust in clinical judgment. It depends on the idea that doing less can sometimes be better medicine. However, that principle collapses when doctors are punished for nuance.
A physician who avoids an unnecessary MRI may still face a complaint. A doctor who declines an opioid refill after a careful assessment may be accused of cruelty. A clinician who refuses to support a weak disability claim may trigger anger, retaliation, or a regulatory report. Even when the physician eventually prevails, the process can be punishing. Legal defense is expensive. Time is lost. Stress spreads into family life, sleep, and future decision-making. The lesson many doctors learn is simple and grim: It is safer to overdo than to explain.
Underfunded health systems make this worse. When patients wait too long, struggle to access specialists, or feel abandoned by the system, frustration often falls on the doctor sitting in front of them. The physician becomes the visible target for an invisible system failure. That is absurd, but it is common. In that setting, defensive medicine becomes a coping mechanism for institutional scarcity. Regulator overreach adds another layer. Oversight matters. Accountability matters. But when regulators treat every complaint as if it signals probable misconduct, they create a culture of fear rather than safety. Physicians then respond rationally to an irrational environment. They practice to avoid accusation, not to maximize value. Social media makes the reputational stakes even harsher. A single allegation, stripped of context, can spread faster than any careful review. A doctor can be tried online before any facts are established. Even a baseless complaint can leave a permanent digital stain. In that world, defensive medicine stops being just a clinical habit. It becomes armor.
Health care cannot claim to want value while tolerating conditions that reward fear. If we want value-based care, we must protect sound clinical judgment, punish bad-faith harassment, fund care properly, and keep oversight fair and proportionate. Otherwise, defensive medicine will keep winning. And it will keep sending the bill to everyone in society.
Olumuyiwa Bamgbade is an accomplished health care leader with a strong focus on value-based health care delivery. A specialist physician with extensive training across Nigeria, the United Kingdom, the United States, and South Korea, Dr. Bamgbade brings a global perspective to clinical practice and health systems innovation.
He serves as an adjunct professor at academic institutions across Africa, Europe, and North America and has published 45 peer-reviewed scientific papers in PubMed-indexed journals. His global research collaborations span more than 20 countries, including Nigeria, Australia, Iran, Mozambique, Rwanda, Kenya, Armenia, South Africa, the U.K., China, Ethiopia, and the U.S.
Dr. Bamgbade is the director of Salem Pain Clinic in Surrey, British Columbia, Canada—a specialist and research-focused clinic. His work at the clinic centers on pain management, health equity, injury rehabilitation, neuropathy, insomnia, societal safety, substance misuse, medical sociology, public health, medicolegal science, and perioperative care.
