Defensive medicine in neurosurgery: the Canadian experience

Abstract

OBJECT Recent studies have examined the impact of perceived medicolegal risk and compared how this perception impacts defensive practices within the US. To date, there have been no published data on the practice of defensive medicine among neurosurgeons in Canada. METHODS An online survey containing 44 questions was sent to 170 Canadian neurosurgeons and used to measure Canadian neurosurgeons’ perception of liability risk and their practice of defensive medicine. The survey included questions on the following domains: surgeon demographics, patient characteristics, type of physician practice, surgeon liability profile, policy coverage, defensive behaviors, and perception of the liability environment. Survey responses were analyzed and summarized using counts and percentages. RESULTS A total of 75 neurosurgeons completed the survey, achieving an overall response rate of 44.1%. Over one-third (36.5%) of Canadian neurosurgeons paid less than $5000 for insurance annually. The majority (87%) of Canadian neurosurgeons felt confident with their insurance coverage, and 60% reported that they rarely felt the need to practice defensive medicine. The majority of the respondents reported that the perceived medicolegal risk environment has no bearing on their preferred practice location. Only 1 in 5 respondent Canadian neurosurgeons (21.8%) reported viewing patients as a potential lawsuit. Only 4.9% of respondents would have selected a different career based on current medicolegal risk factors, and only 4.1% view the cost of annual malpractice insurance as a major burden. CONCLUSIONS Canadian neurosurgeons perceive their medicolegal risk environment as more favorable and their patients as less likely to sue than their counterparts in the US do. Overall, Canadian neurosurgeons engage in fewer defensive medical behaviors than previously reported in the US.

International practice variation in postoperative imaging of chronic subdural hematoma patients

“…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.…”

State medical malpractice laws and utilization of surgical treatment for rotator cuff tear and proximal humerus fracture: an observational cohort study

“…Methodologically, few studies in orthopaedics go beyond survey methods to assess the impact of tort liability on physician treatment choices [ 21 , 62 – 65 ]. Beyond orthopaedics, many studies also simply surveyed physicians [ 21 , 38 , 39 , 53 , 55 , 62 , 66 – 68 ], an approach that is likely to elicit self-interested reporting bias from physicians. We will adopt a more objective measure by examining treatment choices in claim databases.…”

Defensive medicine among neurosurgeons in the Netherlands: a national survey

“…Furthermore, in the USA, unwarranted lawsuits are frequently filed; a previous study found that 85% of lawsuits against neurosurgeons in a tertiary academic center were because the intended benefits of surgery were not seen despite the uneventful operations and were eventually withdrawn [ 7 , 16 , 18 ]. These studies demonstrate why neurosurgeons in the United States pay high malpractice premiums, with neurosurgeons from some US states paying as much as $400,000 annually in insurance premiums [ 15 ]. This is in stark contrast to the Netherlands, where most neurosurgeons pay less than €1000 ($1107).…”

“…These surgeons were reached through the Dutch Neurosurgical Society (Nederlandse Vereniging voor Neurochirurgie), of which all Dutch neurosurgeons are a member. The questionnaire was developed with input from various neurosurgical associations, including the American Association of Neurological Surgery, the American Board of Neurological Surgery, and the Congress of Neurological Surgery, and has been used in previous defensive medicine surveys in the USA [ 14 , 15 ]. Dutch colleagues translated the questions into Dutch and culturally customized them to neurosurgical and legal practices specific to the Netherlands.…”