At the Intersection of Health, Health Care and Policy Cite this article as: Marina Cuttini, Monica Da Frè and Marwan Habiba Perceived Risk Of Malpractice Suits Health Affairs, 32, no.11 (2013):2058 doi: 10.1377/hlthaff.2013.1097
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Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2013 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
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doi:
10.1377/hlthaff.2013.1097
Perceived Risk Of Malpractice Suits Malpractice litigation remains an important challenge for health policy and care. Emily Carrier and coauthors (Aug 2013) highlighted the relationship between physicians’ perception of malpractice risk and patient care. Importantly, they showed that subjective feelings are more influential than average risk. We have shown that obstetricians’ self-reported perception that their practice is influenced, often or occasionally, by fear of malpractice suits is linked to their decision making.1 Obstetricians from representative samples of tertiary care maternity units in France, Germany, Italy, Luxembourg, the Netherlands, Spain, the United Kingdom, and Sweden were surveyed (N ¼ 1530; response rate: 77 percent). Those who felt that fear of malpractice suits “occasionally” influenced their clinical practice were almost twice as likely—and obstetricians whose fear of litigation was more pressing were three times as likely—to report compliance with maternal requests for cesarean section in the absence of medical indications, compared to obstetricians less concerned about being sued. Although the performance of cesarean section on demand is definitely
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without a clear medical indication, the choice of supplemental testing or hospitalization for patients with chest pain, headache, or lower back pain can often be justified on medical grounds, including clinical or best practice guidelines. In addition, these choices may be influenced by physician characteristics such as demographics and type of practice, not only type of specialty. It would thus be interesting to know if Carrier and colleagues could take these factors into account. Finally, it is possible that defensive medicine may operate through influencing what comes to be recognized as clinical norms, thus blurring the distinction between appropriate and defensive practice. Marina Cuttini Bambino Gesù Children’s Hospital ROME , ITALY Monica Da Frè Regional Health Agency of Tuscany FLORENCE , ITALY Marwan Habiba University of Leicester LEICESTER , UNITED KINGDOM NOTE 1 Habiba M, Kaminski M, Da Frè M, Marsal K, Bleker O, Librero J, et al. Caesarean section on request: a comparison of obstetricians’ attitudes in eight European countries. BJOG. 2006;113(6): 647–56.
NOVEMBER 2013
32:11
Downloaded from content.healthaffairs.org by Health Affairs on March 19, 2015 by guest
The online version of this article, along with updated information and services, is available at: http://content.healthaffairs.org/content/32/11/2058.3.full.html
For Reprints, Links & Permissions: http://healthaffairs.org/1340_reprints.php E-mail Alerts : http://content.healthaffairs.org/subscriptions/etoc.dtl To Subscribe: http://content.healthaffairs.org/subscriptions/online.shtml
Health Affairs is published monthly by Project HOPE at 7500 Old Georgetown Road, Suite 600, Bethesda, MD 20814-6133. Copyright © 2013 by Project HOPE - The People-to-People Health Foundation. As provided by United States copyright law (Title 17, U.S. Code), no part of Health Affairs may be reproduced, displayed, or transmitted in any form or by any means, electronic or mechanical, including photocopying or by information storage or retrieval systems, without prior written permission from the Publisher. All rights reserved.
Not for commercial use or unauthorized distribution Downloaded from content.healthaffairs.org by Health Affairs on March 19, 2015 by guest
Letters There is a limit of 300 words for letters to the editor. Health Affairs reserves the right to edit all letters for clarity, length, and tone. Letters can be submitted by e-mail, [email protected], or the Health Affairs website, http:// www.healthaffairs.org.
doi:
10.1377/hlthaff.2013.1097
Perceived Risk Of Malpractice Suits Malpractice litigation remains an important challenge for health policy and care. Emily Carrier and coauthors (Aug 2013) highlighted the relationship between physicians’ perception of malpractice risk and patient care. Importantly, they showed that subjective feelings are more influential than average risk. We have shown that obstetricians’ self-reported perception that their practice is influenced, often or occasionally, by fear of malpractice suits is linked to their decision making.1 Obstetricians from representative samples of tertiary care maternity units in France, Germany, Italy, Luxembourg, the Netherlands, Spain, the United Kingdom, and Sweden were surveyed (N ¼ 1530; response rate: 77 percent). Those who felt that fear of malpractice suits “occasionally” influenced their clinical practice were almost twice as likely—and obstetricians whose fear of litigation was more pressing were three times as likely—to report compliance with maternal requests for cesarean section in the absence of medical indications, compared to obstetricians less concerned about being sued. Although the performance of cesarean section on demand is definitely
2058
H e a lt h A f fai r s
without a clear medical indication, the choice of supplemental testing or hospitalization for patients with chest pain, headache, or lower back pain can often be justified on medical grounds, including clinical or best practice guidelines. In addition, these choices may be influenced by physician characteristics such as demographics and type of practice, not only type of specialty. It would thus be interesting to know if Carrier and colleagues could take these factors into account. Finally, it is possible that defensive medicine may operate through influencing what comes to be recognized as clinical norms, thus blurring the distinction between appropriate and defensive practice. Marina Cuttini Bambino Gesù Children’s Hospital ROME , ITALY Monica Da Frè Regional Health Agency of Tuscany FLORENCE , ITALY Marwan Habiba University of Leicester LEICESTER , UNITED KINGDOM NOTE 1 Habiba M, Kaminski M, Da Frè M, Marsal K, Bleker O, Librero J, et al. Caesarean section on request: a comparison of obstetricians’ attitudes in eight European countries. BJOG. 2006;113(6): 647–56.
NOVEMBER 2013
32:11
Downloaded from content.healthaffairs.org by Health Affairs on March 19, 2015 by guest
