产科诉讼：防御性医疗是否导致剖宫产率上升？

Litigation in obstetrics: does defensive medicine contribute to increases in cesarean delivery?

作者信息

Cheng Yvonne W, Snowden Jonathan M, Handler Stephanie J, Tager Ira B, Hubbard Alan E, Caughey Aaron B

机构信息

Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal-Fetal Medicine, University of California , San Francisco, CA , USA .

出版信息

J Matern Fetal Neonatal Med. 2014 Nov;27(16):1668-75. doi: 10.3109/14767058.2013.879115. Epub 2014 Feb 17.

DOI:10.3109/14767058.2013.879115

PMID:24460458

Abstract

OBJECTIVE

Obstetrics is one of the most sued subspecialties in the US. This study aimed to examine clinicians' medical-legal experience and its association with recommending cesarean delivery.

DESIGN

Cross-sectional convenience survey.

POPULATION OR SAMPLE

This is a survey study of clinicians in the US.

METHODS

Survey included eight common obstetric clinical vignettes and 27 questions regarding clinicians' practice environment. Chi-square test, multivariable logistic regression models were used for statistical comparisons.

MAIN OUTCOME MEASURES

Likelihood of recommending cesarean delivery.

RESULTS

There were 1486 clinicians who completed the survey. Clinicians were categorized based on answers to clinical vignettes. Having had lawsuits and daily worry of suits were associated with higher likelihood of recommending cesarean, compared to those without lawsuits (17.2 versus 11.3%, respectively; p = 0.008) as was frequent worry of lawsuits (every day, 20.3% more likely; every week/month, 12.3%; few times a year/never, 11.4%, p < 0.001).

CONCLUSION

Obstetric malpractice lawsuit and frequent worry about lawsuit are associated with higher propensity of recommending cesarean delivery in common obstetric settings.

摘要

目的

产科是美国被起诉最多的亚专业之一。本研究旨在调查临床医生的医疗法律经验及其与推荐剖宫产的关联。

设计

横断面便利调查。

研究对象或样本

这是一项针对美国临床医生的调查研究。

方法

调查包括八个常见的产科临床案例以及27个关于临床医生执业环境的问题。采用卡方检验和多变量逻辑回归模型进行统计比较。

主要观察指标

推荐剖宫产的可能性。

结果

共有1486名临床医生完成了调查。根据对临床案例的回答对临床医生进行分类。与未遭遇诉讼的医生相比，有过诉讼经历以及每天担心诉讼的医生推荐剖宫产的可能性更高（分别为17.2%和11.3%；p = 0.008），频繁担心诉讼的医生也是如此（每天担心，可能性高20.3%；每周/每月担心，高12.3%；每年几次/从不担心，高11.4%，p < 0.001）。