Malpractice Claim Fears and the Costs of Treating Medicare Patients: A New Approach to Estimating the Costs of Defensive Medicine

ObjectivesRecent years have witnessed a progressive increase in defensive medicine (DM) in several Western welfare countries. In Danish primary and secondary care, documentation on the extent of DM is lacking. Before investigating the extent of DM, we wanted to explore how the phenomenon is understood and experienced in the context of general practice in Denmark. The objective of the study was to describe the phenomenon of DM as understood and experienced by Danish general practitioners (GPs).DesignA qualitative methodology was employed and data were generated through six focus group interviews with three to eight GPs per group (n=28) recruited from the Region of Southern Denmark. Data were analysed using a thematic content analysis inspired by a hermeneutic-phenomenological focus on understanding and meaning.ResultsDM is understood as unnecessary and meaningless medical actions, carried out mainly because of external demands that run counter to the GP’s professionalism. Several sources of pressure to act defensively were identified by the GPs: the system’s pressure to meet external regulations, demands from consumerist patients and a culture among GPs and peers of infallibility and zero-risk tolerance.ConclusionsGPs understand DM as unnecessary and meaningless actions driven by external demands instead of a focus on the patient’s problem. GPs consider defensive actions to be carried out as a result of succumbing to various sources of pressure deriving from the system, the patients, the GPs themselves and peers.

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“…A more recent American study revealed that among specialty groups, primary care physicians contributed the most to DM spending. 15 …”

Section: Introductionmentioning

confidence: 99%

How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners

et al. 2017

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“…Alleged healthcare professionals describe feelings of misery and insecurity both during the process as in its aftermath, and they fear receiving new complaints and provide care more cautiously after the imposed measure [28,29]. This in turn may lead to defensive medicine, which is an important contributor to healthcare costs without adding any benefit to patients [30][31][32][33].…”

Section: Discussionmentioning

confidence: 99%

Medical disciplinary jurisprudence in alleged malpractice in radiology: 10-year Dutch experience

Kwee

2020

Eur Radiol

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Purpose To systematically investigate the frequency and types of allegations related to radiology practice handled by the Dutch Medical Disciplinary Court in the past 10 years. Methods The Dutch Medical Disciplinary Court database was searched for verdicts concerning radiology practice between 2010 and 2019. The association between the number of verdicts and time (years) was assessed by Spearman's rho. Other data were summarized using descriptive statistics. Results There were 48 verdicts (mean 4.8 per year). There was no significant association between the number of verdicts and time (Spearman's rho < 0.001, p = 0.99). Most allegations were in breast imaging and musculoskeletal radiology (each 18.8%), followed by interventional radiology, head and neck imaging, and abdominal imaging (each 12.5%), neuroradiology and vascular imaging (each 10.4%), and chest imaging (4.2%). There were 46 allegations against radiologists (95.8%) and 2 against residents (4.2%). The most common allegation (37.5%) was error in diagnosis. In 20.8% of verdicts, the allegation was judged (partially) founded; disciplinary measures were warnings (n = 8) and reprimands (n = 2). An appeal was submitted by the patient in 11 cases and by the radiologist in 3 cases. All appeals by patients were rejected, whereas 2 of the 3 appeals by radiologists were granted and previously imposed disciplinary measures were reversed. Conclusion Allegations against radiologists at the Dutch Medical Disciplinary Court are relatively few, their number has remained stable over the past 10 years, and a minority were judged to be (partially) founded. We can learn from the cases presented in this article, which may improve patient care. Key Points • The frequency of allegations against radiologists at the Dutch Medical Disciplinary Court is relatively low and has not exhibited any temporal change over the past 10 years. • These allegations reflect patient dissatisfaction, but this infrequently equals malpractice. • Knowledge of the circumstances under which these allegations have arisen may improve patient care.

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“…The nature of medical practice has changed phenomenally during the last decade due to the diversity of social values in societies [1,2]. A striking shift in the decision-making of patients and phy-sicians due to a lack of confidence and insecurity has influenced patient-physician-payer relationships [3,4,18]. This metamorphosis, which is more than a simple change, is more distinct in the field of perinatal medicine where the main concern is the mother and foetus/infant.…”

Section: Discussionmentioning

confidence: 99%

“…All these fluctuations in social variables affect the attitudes of both physicians and patients. This results in defensive medicine and a loss of trust in the service triangle of servers, patients, and payers [3,4].…”

Section: Introductionmentioning

confidence: 99%

Concerns of Pregnant Women in “Prenatal Screening/Diagnosis” Practice and Termination of Pregnancy

Kasnakoğlu

Çakar

Ökem

et al. 2020

Z Geburtshilfe Neonatol

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Objective To investigate the reasons for decision-making and concerns of patients in the field of prenatal screening, invasive prenatal diagnostic testing (IPDT), and termination of pregnancy (TOP). Study Design This questionnaire-based study consisted of 107 pregnant women who were referred for prenatal screening to the Hacettepe University Hospital. The questionnaire given to patients was prepared from scratch since there is no standard set of questions measuring patients’ feelings and concerns regarding prenatal screening/diagnosis, IPDT, and TOP. Results Our questionnaire results showed that it is possible to classify decision-making factors into 6 groups: psychological, social, fear, religious/faith, support, and trust. The majority of patients were undecided (48.6%) about IPDT if prenatal screening test results were risky. Only 23.4% of patients were willing to accept IPDT. On the other hand, 55.1% of patients were not willing to undergo TOP if the fetal karyotyping results were abnormal. Religious factors seem to be important in refusing IPDT and TOP. Conclusion Physicians should re-evaluate their practice in the field of prenatal screening and diagnosis in light of the high refusal rates of IPDT and TOP. Understanding factors influencing womenʼs decision-making processes provides insight for service providers to help women at high risk of having foetal anomalies to make better-informed choices.

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Malpractice Claim Fears and the Costs of Treating Medicare Patients: A New Approach to Estimating the Costs of Defensive Medicine

Abstract: Although results are based on measured associations between malpractice fears and spending, and may not reflect the true causal effects, they suggest defensive medicine likely contributes substantial additional costs to Medicare.

Cited by 53 publications

References 29 publications

How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners

How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners

Medical disciplinary jurisprudence in alleged malpractice in radiology: 10-year Dutch experience

Concerns of Pregnant Women in “Prenatal Screening/Diagnosis” Practice and Termination of Pregnancy

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