Customize your JAMA Network experience by selecting one or more topics from the list below.
Studdert DM, Mello MM, Sage WM, et al. Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment. JAMA. 2005;293(21):2609–2617. doi:10.1001/jama.293.21.2609
Author Affiliations: Department of Health Policy
and Management, Harvard School of Public Health (Drs Studdert, Mello, DesRoches,
and Brennan), Department of Medicine, Harvard Medical School (Dr Brennan),
and Department of Medicine, Brigham and Women’s Hospital (Dr Brennan),
Boston, Mass; Columbia Law School, New York, NY (Dr Sage); and Harris Interactive
Inc, Rochester, NY (Mr Peugh and Dr Zapert).
Context How often physicians alter their clinical behavior because of the threat
of malpractice liability, termed defensive medicine,
and the consequences of those changes, are central questions in the ongoing
medical malpractice reform debate.
Objective To study the prevalence and characteristics of defensive medicine among
physicians practicing in high-liability specialties during a period of substantial
instability in the malpractice environment.
Design, Setting, and Participants Mail survey of physicians in 6 specialties at high risk of litigation
(emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology,
and radiology) in Pennsylvania in May 2003.
Main Outcome Measures Number of physicians in each specialty reporting defensive medicine
or changes in scope of practice and characteristics of defensive medicine
(assurance and avoidance behavior).
Results A total of 824 physicians (65%) completed the survey. Nearly all (93%)
reported practicing defensive medicine. “Assurance behavior” such
as ordering tests, performing diagnostic procedures, and referring patients
for consultation, was very common (92%). Among practitioners of defensive
medicine who detailed their most recent defensive act, 43% reported using
imaging technology in clinically unnecessary circumstances. Avoidance of procedures
and patients that were perceived to elevate the probability of litigation
was also widespread. Forty-two percent of respondents reported that they had
taken steps to restrict their practice in the previous 3 years, including
eliminating procedures prone to complications, such as trauma surgery, and
avoiding patients who had complex medical problems or were perceived as litigious.
Defensive practice correlated strongly with respondents’ lack of confidence
in their liability insurance and perceived burden of insurance premiums.
Conclusion Defensive medicine is highly prevalent among physicians in Pennsylvania
who pay the most for liability insurance, with potentially serious implications
for cost, access, and both technical and interpersonal quality of care.
Create a personal account or sign in to: