Despite the many exhortations to eschew its practice, defensive medicine is here to stay (Avoid practising defensive medicine, docs told; Aug 2).

Laymen, with the benefit of hindsight, think that diagnoses are cut and dried, and that the trained eye of the doctor should spot all abnormalities.

In reality, many conditions start off innocuously enough, with indeterminate symptoms and signs, but can deteriorate into life-threatening situations in no time.

The practice of medicine is demanding.

There is a fair amount of uncertainty and probability estimation over and above clinical acumen in the diagnosis, investigation and management of any medical condition.

A comprehensive explanation of the likely condition - whether the patient has been given all relevant info on diagnosis, investigating and treatment modalities - is an added test of whether the doctor has been negligent.

Patients who think they know better will choose to have costly tests and treatments administered, for the sake of "safety first", even if they are unnecessary in retrospect.

Is it any wonder that defensive medicine will become even more pervasive?

Yik Keng Yeong (Dr)