Defensive medicine among neurosurgeons in the Netherlands: a national survey

Abstract

ObjectiveIn defensive medicine, practice is motivated by legal rather than medical reasons. Previous studies have analyzed the correlation between perceived medico-legal risk and defensive behavior among neurosurgeons in the United States, Canada, and South Africa, but not yet in Europe. The aim of this study is to explore perceived liability burdens and self-reported defensive behaviors among neurosurgeons in the Netherlands and compare their practices with their non-European counterparts.MethodsA survey was sent to 136 neurosurgeons. The survey included questions from several domains: surgeon characteristics, patient demographics, type of practice, surgeon liability profile, policy coverage, defensive practices, and perception of the liability environment. Survey responses were analyzed and summarized.ResultsForty-five neurosurgeons filled out the questionnaire (response rate of 33.1%). Almost half (n = 20) reported paying less than 5% of their income to annual malpractice premiums. Nearly all respondents view their insurance premiums as a minor or no burden (n = 42) and are confident that in their coverage is sufficient (n = 41). Most neurosurgeons (n = 38) do not see patients as “potential lawsuits”.ConclusionsRelative to their American peers, Dutch neurosurgeons view their insurance premiums as less burdensome, their patients as a smaller legal threat, and their practice as less risky in general. They are sued less often and engage in fewer defensive behaviors than their non-European counterparts. The medico-legal climate in the Netherlands may contribute to this difference.

International practice variation in postoperative imaging of chronic subdural hematoma patients

“…Most notably, it is uncommon for patients to sue their physicians in the Netherlands, and Dutch neurosurgeons experience little burden from lawsuits or liability premiums. 42 These remarkable differences are likely to play some role in the differences in utilization of diagnostic tests, which we report in our study.…”

“…Defensive behaviors vary geographically, with neurosurgeons in areas with unfavorable liability climates practicing more defensively. 7,35,36,42 The Dutch medicolegal climate is very different from the American one. Most notably, it is uncommon for patients to sue their physicians in the Netherlands, and Dutch neurosurgeons experience little burden from lawsuits or liability premiums.…”

Defensive medicine in Europe: a ‘full circle’?

“…DM practice is generally divided into two categories [1,17]: (1) 'positive' DM occurs when physicians prescribe unnecessary or repetitive tests, referrals and/or procedures;…”

“…In Northern European countries (such as Denmark, the Netherlands and Sweden), where patients' complaints can be addressed earlier in alternative sites (e.g. medical disciplinary boards) before arriving in the courts [3,6,17], physicians are less financially liable for non-gross negligence. In these nations, DM seems to be perceived as a less pressing issue at present, more like a future threat in the case of growing 'Americanization' of European healthcare systems and more frequent recourse to court claims as a consequence [17].…”

How defensive medicine is defined and understood in European medical literature: protocol for a systematic review

“…In these countries, the medicolegal system does not hold physicians financially liable for malpractice or other treatment related adverse events. The patients are instead compensated by the government (known as a no-fault system) 21–23. Nevertheless, DM seems also to be prevalent in Europe, for example Denmark,13 the UK,24 Italy,12 Belgium,25 The Netherlands,2 Germany26 and Switzerland 20.…”