Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment

Studdert, D.M.; Mello, Mike; Sage, William M.

doi:10.1016/j.accreview.2005.10.009

Cited by 132 publications

(186 citation statements)

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“…This is an important area for future research, not least because the health care sector has become much more open and transparent to the public over the past few years. 3 Including unspecified, mild and severe preeclampsia 4 Whether the mother has one or more of the following diseases: asthma, diabetes, epilepsy, heart disease, chronic hypertension, chronic kidney failure, rheumatoid arthritis 5 Reference category: ≥ 2500 g 6 Reference category: 37-41 weeks 7 Including breech presentation, transverse presentation, abnormal cephalic presentation and other.…”

Section: Resultsmentioning

confidence: 99%

“…The underlying idea is that physicians care about their reputation, and therefore they want to avoid negative publicity in the mass media. One way to avoid negative 5 publicity is to practice defensive medicine. Defensive medicine has been studied extensively in the USA.…”

Section: Introductionmentioning

confidence: 99%

“…The focus in most of the studies has been to examine whether physicians deviate from sound medical practice because they fear malpractice claims. In that case, physicians supply medical services of no or only marginal value because they want to reduce the risk of adverse outcomes [5]. For example, they may order more tests than are medically necessary or choose types of treatment with little risk of making errors.…”

Section: Introductionmentioning

confidence: 99%

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The impact of the mass media on obstetricians’ behavior in Norway

2017

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Little is known about how physicians and hospitals respond to the risk of being negatively exposed in the mass media. We assume that newspapers will cover events more closely in the areas where they have most of their circulation. Within such areas the likelihood of negative publicity increases. The research question is whether obstetricians respond to negative newspaper coverage by choosing the least risky method of delivery, i.e. Caesarean section. This was tested on a large set of data from the Medical Birth Registry of Norway for the period 2000-2011. The Registry contains detailed medical information about all deliveries, for both the mother and the infant. This set of data was merged with a set of data that contained information about newspaper coverage for the municipalities in which all hospitals were located. Altogether, more than 620 000 deliveries in 46 municipalities were included in the study. The data were analyzed using a hospital 3 fixed effects regression. The main result was that newspaper coverage had a significant positive effect on the probability of having a Caesarean section. Several supplementary analyses supported the main finding. Altogether, our results indicate that obstetricians are sensitive to the risk of being exposed in the mass media. This is likely to be because obstetricians care about their reputation.

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Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The impact of the mass media on obstetricians’ behavior in Norway

2017

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“…Physicians, however, have additional components of dealing with very vulnerable population and an over-looming fear of litigation (Studdert et al 2005;Mello et al 2013). Several studies have shown that physicians often practice what is termed as defensive medicine, i.e.…”

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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“…The costs do not include the cost of defensive medicine, i.e. medical tests, procedures or visits to reduce exposure to malpractice liability (Studdert et al 2005;Kessler et al 2006). Although these indirect costs are unknown, raw estimates are available.…”

Section: Administration Costsmentioning

confidence: 99%