Legal concerns trigger prostate‐specific antigen testing

Abstract

Background In the United States, lawsuits against physicians have had an impact on their behaviour, resulting in overdiagnosis and other forms of 'defensive medicine'. Does a similar situation exist in Switzerland? Using prostate-specific antigen (PSA) screening as an example, we surveyed Swiss physicians and assessed the extent to which liability fears influenced their recommendation for testing. Methods At a continuing medical education conference we distributed a pilot-tested questionnaire to 552 participants. Two hundred and fifty of them (45%) completed the questionnaire. Results Of the participants, 158 (68%) were general practitioners and 73 (32%) specialists in internal medicine. Seventy-five per cent of both groups recommend regular PSA screening to men older than age 50. Yet only 56% of the general physicians and 53% of the internists believe that PSA measurement is an effective screening method. A substantial proportion of the physicians -41% of general practitioners and 43% of internists -reported that they sometimes or often recommend this test for legal reasons. Conclusions Defensive medicine is not a phenomenon particular to the USA, but is also observable in Switzerland. This result is surprising, given that in Switzerland and other European countries, a physician who does not recommend a test or treatment whose effectiveness is controversial need not fear litigation.

Population-Based Patterns and Predictors of Prostate-Specific Antigen Screening Among Older Men in the United States

“…28 Elevated screening rates of elderly men with limited life expectancies may also reflect defensive medicine in response to previous litigation stemming from the decision not to offer prostate cancer screening. 29–31 …”

Cancer Screening Rates in Individuals With Different Life Expectancies

“…tice of defensive medicine and fear of litigation [33][34][35] may further contribute to overscreening. A prior study 36 that demonstrated routine screenings in patients with advanced cancer showed a similar pattern (though of a smaller magnitude) in another group of individuals in whom omission of screening should be relatively uncontroversial.…”

Public Knowledge of Benefits of Breast and Prostate Cancer Screening in Europe

“…After family and friends, whose information might actually derive from the other sources in Table 3, the most frequently mentioned sources were general practitioner and pharmacist. Studies on physicians’ lack of knowledge about the benefits of screening and conflicts of interest support the possibility that these professionals contribute to overestimation (6,16,22). The observation that health-specific sources rarely improve understanding of screening (except for health insurance in several countries) also implicates these sources as a further potential cause, a hypothesis that is consistent with the findings that few pamphlets, letters of invitation, and Web sites explain the size of the benefit.…”