Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusets, United States of America.
PLoS One. 2012;7(6):e39237. doi: 10.1371/journal.pone.0039237. Epub 2012 Jun 22.
Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons' perceptions of malpractice liability and defensive medicine practices.
A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices.
A total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a "major or extreme" burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns.
Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.
对医疗保健支出不断增加的担忧导致对医疗实践的审查越来越严格。随着医疗责任和医疗事故风险上升到危机水平，医疗法律环境导致了防御性医疗的出现，因为医生试图减轻责任风险。高风险专业，如神经外科，尤其受到影响，神经外科医生改变了他们的实践以降低医疗法律风险。我们首次对美国神经外科医生对医疗事故责任和防御性医疗实践的看法进行了全国性调查。
向美国神经外科学会（American Association of Neurological Surgeons）的 3344 名执业美国神经外科医生会员发送了一份经过验证的、有 51 个问题的在线调查，该协会代表了学术和私人执业中的 76%的神经外科医生。
共有 1028 名神经外科医生（31%的回应率）完成了调查，他们代表了各种亚专科实践。调查对象通过开具额外的影像学检查（72%）、实验室检查（67%）、将患者转介给顾问（66%）或开处方（40%）来采取防御性医疗措施。64%的受访者认为医疗事故保险费是“主要或极端”的负担，这导致 45%的受访者因责任问题而从他们的实践中取消高风险手术。
对医疗责任的担忧和看法导致医生采取防御性医疗措施。因此，为了满足感知到的法律风险，进行了诊断性检查、咨询和影像学检查，导致医疗保健支出增加。为了最大限度地降低医疗事故风险，一些神经外科医生已经取消了高风险手术。如果不加控制，对医疗责任的担忧将进一步推动防御性医疗实践，限制患者获得医疗服务的机会，并增加美国医疗保健服务的成本。
