Excessive Utilization of Laboratory Investigations and its Relationship with Defensive Medicine Practice: A Saudi Arabia Perspective

Document Type : Narrative Review


1 Health Services Management, Faculty of Applied Medical Sciences, Umm Al-Qura University, Saudi Arabia

2 International Research Collaborative-Oral Health and Equity, School of Human Sciences, The University of Western Australia, Crawley, WA, Australia


There is a growing deviated physicians' practice regarding laboratory requests due to fear of failing to notice something important, fear of being criticized by superiors for neglecting a test or not coping with the uncertainties related to diagnoses, and so-called defensive testing. This behavior was attributed to the health system culture of fear and the lack of transparency of the costs associated with such unnecessary health care services. A literature search was carried out on these topics: laboratory management, laboratory testing, test requesting, test ordering, physicians' ordering behavior, cost reduction, appropriateness and efficiency using evidence-based resources, including peer-review publications until 2019. The negative impact of defensive medicine practice exceeds the economic consequences and necessarily reduces the patient outcomes and the total quality of patient care. A consensus between experts that the root cause of defensive medicine began with the increasing number of medical malpractice lawsuits. In Saudi Arabia, malpractice claims increased by 416% between 2008 and 2013. Multiple solutions have been suggested for the problem of inappropriate laboratory testing and defensive testing, but no single approach has been widely adopted. Combined strategies proved to be more effective and more durable. Building a culture of trust inside the health system is increasingly perceived as a significant influence on health system functioning.