This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Citing articles on Web of Science (109)  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Medical Practice  • Law and Medicine  • Patient-Physician Relationship/ Care  • Patient-Physician Communication  • Quality of Care  • Quality of Care, Other  • Alert me on articles by topic  Social Bookmarking   What's this?

David M. Studdert, LLB, ScD, MPH; Michelle M. Mello, JD, PhD, MPhil; William M. Sage, MD, JD; Catherine M. DesRoches, DrPH; Jordon Peugh, MA; Kinga Zapert, PhD; Troyen A. Brennan, MD, JD, MPH

JAMA. 2005;293:2609-2617.

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.

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).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

In Defense of Body CT
McCollough et al.
Am. J. Roentgenol. 2009;193:28-39.
ABSTRACT | FULL TEXT  

Commentary: Lawyer Phobia
Tellefsen
J Am Acad Psychiatry Law 2009;37:162-164.
ABSTRACT | FULL TEXT  

Do Clinicians Use the American College of Radiology Appropriateness Criteria in the Management of Their Patients?
Bautista et al.
Am. J. Roentgenol. 2009;192:1581-1585.
ABSTRACT | FULL TEXT  

The Cost of End-of-Life Care: A New Efficiency Measure Falls Short of AHA/ACC Standards
Neuberg
Circ Cardiovasc Qual Outcomes 2009;2:127-133.
FULL TEXT  

Biases in Radiologic Reasoning
Gunderman
Am. J. Roentgenol. 2009;192:561-564.
ABSTRACT | FULL TEXT  

The unbearable lightness of diagnostic testing: time to contain inappropriate test ordering
Schattner
Postgrad. Med. J. 2008;84:618-621.
ABSTRACT | FULL TEXT  

Medical Malpractice and the Chest Physician
Luce
Chest 2008;134:1044-1050.
ABSTRACT | FULL TEXT  

Invited Article: Professionalism in neurology: The role of law
Larriviere and Beresford
Neurology 2008;71:1283-1288.
ABSTRACT | FULL TEXT  

Quality of dying in a New Zealand teaching hospital
Glasgow et al.
Qual Saf Health Care 2008;17:244-248.
ABSTRACT | FULL TEXT  

Comparison of the Simplify D-dimer assay performed at the bedside with a laboratory-based quantitative D-dimer assay for the diagnosis of pulmonary embolism in a low prevalence emergency department population
Runyon et al.
Emerg. Med. J. 2008;25:70-75.
ABSTRACT | FULL TEXT  

Influence of Obstetric Practice on Workload and Practice Patterns of Family Physicians and Obstetrician-Gynecologists
Dresden et al.
Ann Fam Med 2008;6:S5-S11.
ABSTRACT | FULL TEXT  

Health Care: A Fertile Field for Service Research
Berry and Bendapudi
Journal of Service Research 2007;10:111-122.
ABSTRACT  

Patient-Focused Care
Spinello et al.
Chest 2007;132:734-735.
FULL TEXT  

Malpractice Liability Costs And The Practice Of Medicine In The Medicare Program
Baicker et al.
Health Aff (Millwood) 2007;26:841-852.
ABSTRACT | FULL TEXT  

Changes In Physician Supply And Scope Of Practice During A Malpractice Crisis: Evidence From Pennsylvania
Mello et al.
Health Aff (Millwood) 2007;26:w425-w435.
ABSTRACT | FULL TEXT  

Does Radiologist Recommendation for Follow-up with the Same Imaging Modality Contribute Substantially to High-Cost Imaging Volume?
Lee et al.
Radiology 2007;242:857-864.
ABSTRACT | FULL TEXT  

Current Issues in Health Policy: A Primer for the Orthopaedic Surgeon
Sharan D. et al.
J Am Acad Orthop Surg 2007;15:76-86.
ABSTRACT | FULL TEXT  

e-Prescribing, Efficiency, Quality: Lessons from the Computerization of UK Family Practice
Schade et al.
J. Am. Med. Inform. Assoc. 2006;13:470-475.
ABSTRACT | FULL TEXT  

Claims, errors, and compensation payments in medical malpractice litigation.
Studdert et al.
NEJM 2006;354:2024-2033.
ABSTRACT | FULL TEXT  

No-Fault Compensation In New Zealand: Harmonizing Injury Compensation, Provider Accountability, And Patient Safety
Bismark and Paterson
Health Aff (Millwood) 2006;25:278-283.
ABSTRACT | FULL TEXT  

Improving Relations Between Attorneys and Physicians
Jacobson and Bloche
JAMA 2005;294:2083-2085.
FULL TEXT  

Clinical Decision Instruments for CT Scanning in Minor Head Injury
Haydel
JAMA 2005;294:1551-1553.
FULL TEXT  

Physician Responses to the Malpractice Crisis: From Defense to Offense
Kachalia et al.
J Law Med Ethics 2005;33:416-428.
 

Malpractice in Mexico: arbitration not litigation
Tena-Tamayo and Sotelo
BMJ 2005;331:448-451.
FULL TEXT  

Defensive Medicine Is Prevalent in High-Risk Disciplines
JWatch Emergency Med. 2005;2005:8-8.
FULL TEXT  

Defensive Medicine and the Malpractice Environment
Journal Watch Dermatology 2005;2005:15-15.
FULL TEXT  

Defensive Medicine and the Malpractice Environment
JWatch Gastroenterology 2005;2005:8-8.
FULL TEXT  

Defensive Medicine and the Malpractice Environment
JWatch General 2005;2005:2-2.
FULL TEXT  

Tort Reform and the Patient Safety Movement: Seeking Common Ground
Budetti
JAMA 2005;293:2660-2662.
FULL TEXT