Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA.
Semin Perinatol. 2012 Oct;36(5):390-4. doi: 10.1053/j.semperi.2012.04.025.
Both the rates of cesarean section and the rates and payouts from obstetrical malpractice suits have risen in past decades, albeit not always in tandem. A great deal of evidence suggests that physicians practice defensive medicine, and many obstetricians acknowledge that a more liberal recourse to cesarean section is one such behavior in which they sometimes engage. However the degree to which fear of litigation actually is a contributor to, or perhaps even a driver of, the rising cesarean section rate is not as clearly known. In this article I will discuss the research that has been performed that attempts to epidemiologically assess the link between lawsuits, malpractice premiums and cesarean section rates. I will also consider factors beyond dollars and cents (e.g., cognitive biases, changing risk tolerance of doctors and patients) that may lie at the base of the relationship. Finally I will offer a brief discussion of how professional ethics should inform the actions that physicians take in these difficult circumstances.
在过去几十年中，剖宫产率以及产科医疗事故诉讼的发生率和赔付额都有所上升，尽管并非总是同步上升。大量证据表明，医生采取了防御性医疗措施，许多产科医生承认，更自由地采用剖宫产术是他们有时会采取的一种行为。然而，诉讼的恐惧实际上在多大程度上导致了剖宫产率的上升，或者甚至是其驱动因素，这一点并不清楚。在本文中，我将讨论已经进行的旨在从流行病学角度评估诉讼、医疗事故保险费和剖宫产率之间联系的研究。我还将考虑超出金钱因素（例如，认知偏差、医生和患者风险容忍度的变化）的因素，这些因素可能是这种关系的基础。最后，我将简要讨论职业道德应如何为医生在这些困难情况下的行为提供信息。
