Effect of physician strategies for coping with the US medical malpractise crisis on healthcare delivery and patient access to healthcare

Dalton, George D.; Samaropoulos, Xanthia F.; Dalton, A.C.

doi:10.1016/j.puhe.2008.01.010

Cited by 9 publications

(8 citation statements)

References 39 publications

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“…These behaviors include practicing defensive medicine [3,4], failing to report incidents [5-7], and hesitating to disclose incidents to patients [8,9]. Defensive medicine includes performing unnecessary medical procedures [10] and tests [11], deviating from guideline practices [12] and avoiding high-risk patients [3]. Malpractice litigation risk influences physicians’ behaviors that run counter to patient safety [3,6-11].…”

Section: Introductionmentioning

confidence: 99%

“…Defensive medicine includes performing unnecessary medical procedures [10] and tests [11], deviating from guideline practices [12] and avoiding high-risk patients [3]. Malpractice litigation risk influences physicians’ behaviors that run counter to patient safety [3,6-11]. After an incident, patients may start legal action against health care workers to prevent similar incidents in the future, to find out how the incident happened and why, to receive financial compensation, or to hold staff or organizations accountable for their actions [13,14].…”

Section: Introductionmentioning

confidence: 99%

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Conditions that influence the impact of malpractice litigation risk on physicians’ behavior regarding patient safety

Renkema

Broekhuis

Ahaus

2014

BMC Health Serv Res

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BackgroundPracticing safe behavior regarding patients is an intrinsic part of a physician’s ethical and professional standards. Despite this, physicians practice behaviors that run counter to patient safety, including practicing defensive medicine, failing to report incidents, and hesitating to disclose incidents to patients. Physicians’ risk of malpractice litigation seems to be a relevant factor affecting these behaviors. The objective of this study was to identify conditions that influence the relationship between malpractice litigation risk and physicians’ behaviors.MethodsWe carried out an exploratory field study, consisting of 22 in-depth interviews with stakeholders in the malpractice litigation process: five physicians, two hospital board members, five patient safety staff members from hospitals, three representatives from governmental healthcare bodies, three healthcare law specialists, two managing directors from insurance companies, one representative from a patient organization, and one representative from a physician organization. We analyzed the comments of the participants to find conditions that influence the relationship by developing codes and themes using a grounded approach.ResultsWe identified four factors that could affect the relationship between malpractice litigation risk and physicians’ behaviors that run counter to patient safety: complexity of care, discussing incidents with colleagues, personalized responsibility, and hospitals’ response to physicians following incidents.ConclusionIn complex care settings procedures should be put in place for how incidents will be discussed, reported and disclosed. The lack of such procedures can lead to the shift and off-loading of responsibilities, and the failure to report and disclose incidents. Hospital managers and healthcare professionals should take these implications of complexity into account, to create a supportive and blame-free environment. Physicians need to know that they can rely on the hospital management after reporting an incident. To create realistic care expectations, patients and the general public also need to be better informed about the complexity and risks of providing health care.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Conditions that influence the impact of malpractice litigation risk on physicians’ behavior regarding patient safety

Renkema

Broekhuis

Ahaus

2014

BMC Health Serv Res

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“…Respondents were grouped based on the malpractice crisis level of their state. The three levels are “crisis,”“cautious” (meaning states were showing warning signs), and “stable.” States were categorized based on the American Medical Association medical liability crisis map as printed in Dalton et al (2008). A total of 42% of respondents practice in a crisis state, 30% practice in a cautious state, and 28% practice in a stable state.…”

Section: Resultsmentioning

confidence: 99%

“…Increasing costs of malpractice insurance and the fear of liability suits have been a significant problem for physicians (Charles, 2003; Mello, Studdert, & Brennan, 2003). Fears of liability claims have been associated with changes in physician practices; for example physicians have eliminated high‐risk services and increasingly practice defensive medicine to reduce malpractice risk (e.g., Dalton, Samaropoulos, & Dalton, 2008). Malpractice fears have also been associated with physicians' well‐being; as one sample of the Central Association of Obstetricians and Gynecologists demonstrates, liability experience and concerns have caused physicians to experience psychological trauma, doubt, and shame (McAninch et al, 2008).…”

Section: Review Of the Literaturementioning

confidence: 99%

Study on Defensive Medicine Practices among Obstetricians and Gynecologists Who Provide Breast Care

Anderson

Strunk

Schulkin

2011

Journal for Healthcare Quality

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The purpose of this study was to assess malpractice concerns, career satisfaction, defensive medicine, experience with liability lawsuits, and changes in breast care practices among obstetricians and gynecologists (ob-gyns) who provide breast care. Four hundred ACOG Fellows were randomly selected and invited to participate, 247 (62%) responded. A majority of responders had increased the number of referrals for the diagnosis of breast abnormalities (58.9%) and treatment of breast disease (53.6%) due to fears and concerns regarding malpractice. On average, there was a high level of career satisfaction (M=8.5 [SD=2.5] on a scale from 0 to 10); however, those who had been sued were significantly less satisfied than those who had not. Physicians who had decreased breast surgical procedures and increased referrals for diagnosis and treatment of breast disease reported practicing defensive medicine more frequently. In a regression analysis, having been sued was a significant predictor of practicing defensive medicine more often. Physicians from states with malpractice crisis reported practicing defensive medicine more frequently and more lawsuits than physicians from stable states. Malpractice fears and defensive medicine continue to affect the practices of ob-gyns, most specifically, as this study shows, ob-gyns who provide breast care.

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“…Beyond debates about healthcare costs (Thomas et al 2010), effects on quality and access to healthcare (Dalton et al 2008), the issue of defensive medicine is of major sociological interest as it is closely linked to current transformations of the medical profession. Within this framework, this paper aims to contribute to current sociological debates surrounding physicians' professional autonomy by examining how obstetrician-gynaecologists in Switzerland perceive and respond to the risk of malpractice claims.…”

Section: Introductionmentioning

confidence: 99%

Risk of Malpractice Claims and Changes in Professional Autonomy: A Qualitative Study of Obstetrician-Gynaecologists in Switzerland

Hammer

2017

Swiss Journal of Sociology

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Based on interviews, this article explores how obstetrician-gynaecologists in Switzerland deal with and respond to the risk of malpractice claims. It describes the factors associated with the interviewees' perceived increasing risk of litigation, as well as three attitudes towards the use of consent forms as a means of managing such a risk. This article suggests that the perceived risk of claims is closely linked to the physicians' perception of how external regulation shapes their professional autonomy.

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Effect of physician strategies for coping with the US medical malpractise crisis on healthcare delivery and patient access to healthcare

Cited by 9 publications

References 39 publications

Conditions that influence the impact of malpractice litigation risk on physicians’ behavior regarding patient safety

Conditions that influence the impact of malpractice litigation risk on physicians’ behavior regarding patient safety

Study on Defensive Medicine Practices among Obstetricians and Gynecologists Who Provide Breast Care

Risk of Malpractice Claims and Changes in Professional Autonomy: A Qualitative Study of Obstetrician-Gynaecologists in Switzerland

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