Emergency Physicians' Fear of Malpractice in Evaluating Patients With Possible Acute Cardiac Ischemia

Katz, David A.; Williams, Geoffrey; Brown, Roger; Aufderheide, Tom P.; Bogner, Mark; Rahko, Peter S.; Selker, Harry P.

doi:10.1016/j.annemergmed.2005.04.016

Cited by 218 publications

(151 citation statements)

References 30 publications

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“…38 Fear of malpractice was measured using two of six questions from a previously published measure (Q1:I feel pressured in my day- Table 1a to-day practice by the threat of malpractice litigation, Q2:I order some tests or consultations to reduce by risk of being sued; 5 point-strongly disagree to strongly agree;Cronbach's alpha 0.76, in our study). 39,40 Physicians reported practice characteristics, including the average number of outpatients seen weekly and practice type (i.e., solo, single specialty group, multispecialty group). Practice census division and rurality were determined from the mailing ZIP codes, using Rural Urban Commuting Area (RUCA) codes to designate level of rurality.…”

Section: Independent Variablesmentioning

confidence: 99%

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

et al. 2013

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Section: Independent Variablesmentioning

confidence: 99%

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

et al. 2013

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“…27 Other studies have investigated characteristics of physicians that may affect the decision-making process, such as their attitudes toward risk, fear of malpractice, and bias. [28][29][30] in a prospectively identified cohort of patients with chest pain meeting enrolment criteria for a study of coronary computed tomographic angiography (CCTA) and admitted for a ''rule out ACS'' protocol.…”

Section: Ré Sumémentioning

confidence: 99%

Emergency physician estimates of the probability of acute coronary syndrome in a cohort of patients enrolled in a study of coronary computed tomographic angiography

Lee

Hoffmann²,

Bamberg³

et al. 2012

CJEM

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Introduction: Little information exists regarding how accurately emergency physicians (EPs) predict the probability of acute coronary syndrome (ACS). Our objective was to determine if EPs can accurately predict ACS in a prospectively identified cohort of emergency department (ED) patients who met enrolment criteria for a study of coronary computed tomographic angiography (CCTA) and were admitted for a ''rule out ACS'' protocol. Methods: A prospective observational pilot study in an academic medical centre was carried out. EPs caring for patients with chest pain provided whole-number estimates of the probability of ACS after clinical review. This substudy was part of the now published Rule Out Myocardial Infarction/ Ischemia Using Computer Assisted Tomography (ROMICAT) study, a study of CCTA and admission of patients for a rule out ACS protocol after a nondiagnostic evaluation. Predictions were grouped into probability groups based on the validated Goldman criteria. ACS was determined by an adjudication committee using American Heart Association/American College of Cardiology/European Society of Cardiology guidelines. Results: A total of 334 predictions were obtained for a study population with a mean age of 54 (SD 12) years, 63% of whom were male. There were 35 ACS events. EPs predicted ACS better than by chance, and increasingly higher estimates were associated with a higher incidence of ACS (p 5 0.0004). The percentage of patients with ACS was 0%, 6%, 7%, and 17%, respectively, for very low, low, intermediate, and high probability groups. EPs' estimates had a sensitivity of 63% using a . 20% probability of ACS to define a positive test. Lowering this threshold to . 7% to define a test as positive increased the sensitivity of physician estimates to 89% but lowered specificity from 65% to 24%.

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“…Several studies have shown that physicians often practice what is termed as defensive medicine, i.e. order tests or procedures, primarily due to fear of litigation (Kessler & McClellan 1996, Studderrt, et al 2005Katz et al 2005).…”

Section: The Formation Of Doctorsmentioning

confidence: 99%

Can Doctors Maintain Good Character? An Examination of Physician Lives

Fatima

2016

J Med Humanit

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Can doctors maintain good character? This paper shifts the focus from patient care to ethical considerations that bear on the physician and impact her as a person. By decentering patient care, the paper highlights certain factors that habituate a particular way of reasoning that is not conducive to inculcating good character. Such factors include, standards of professionalism, being influenced by external monitors, and emphasis on adherence to guidelines. While such factors may benefit patients, they often adversely affect the character of physicians.Keywords Character . Physician . Professionalism . Virtue . Empathy . Compassion Dr. Philips' day at the clinic was finally ending. She had seen twenty-five patients in a span of eight hours, and just as she was ready to go home, her pager buzzed. Her forty-week-pregnant patient was just admitted in active labor, only four cm dilated. As she changed into her green scrubs, she could not help but think about missing yet another family dinner and possibly staying on-call overnight. Natural labor can take up to sixteen hours to deliver a baby. However, if the labor is augmented with medication or with early breaking of the amniotic fluid, it can progress faster. Her patient was full term and could potentially benefit from a timely delivery, but an induced labor could also increase the patient's chances of a Caesarian birth. Dr. Phillips decides to proceed with induced labor. The next morning, Dr. Phillips is admiring the picture of herself with the baby and the mother. Of course she missed seeing her kids for dinner, but she was able to rest before her morning shift, and the new mother and baby were doing well. This paper examines the myriad reasons that a doctor invariably takes into consideration while making medical decisions within everyday settings and the way that such reasoning impacts character. By 'everyday setting,' I refer to the real life circumstances that physicians in the United States operate in, where established standards of care aim at achieving optimum

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Emergency Physicians' Fear of Malpractice in Evaluating Patients With Possible Acute Cardiac Ischemia

Abstract: Malpractice fear accounts for significant variability in ED decisionmaking and is associated with increased hospitalization of low-risk patients and increased use of diagnostic tests.

Cited by 218 publications

References 30 publications

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

Guideline-Inconsistent Breast Cancer Screening for Women over 50: A Vignette-Based Survey

Emergency physician estimates of the probability of acute coronary syndrome in a cohort of patients enrolled in a study of coronary computed tomographic angiography

Can Doctors Maintain Good Character? An Examination of Physician Lives

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