Smith Timothy R, Habib Ali, Rosenow Joshua M, Nahed Brian V, Babu Maya A, Cybulski George, Fessler Richard, Batjer H Hunt, Heary Robert F
*Department of Neurological Surgery, Northwestern University, Chicago, Illinois; ‡Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusetts; §Department of Neurological Surgery, Mayo Medical School, Rochester, Minnesota; ¶Department of Neurological Surgery, UMDNJ-New Jersey Medical School, Newark, New Jersey.
Neurosurgery. 2015 Feb;76(2):105-13; discussion 113-4. doi: 10.1227/NEU.0000000000000576.
Defensive medicine is prevalent among US neurosurgeons due to the high risk of malpractice claims. This study provides national estimates of US neurosurgeons' defensive behaviors and perceptions.
To examine the relationship of defensive medicine-both "assurance" behaviors and "avoidance" behaviors-to the liability environment.
A 51-question online survey was sent to 3344 US neurosurgeon members of the American Board of Neurological Surgeons (ABNS). The survey was anonymous and conducted over 6 weeks in the spring of 2011. The previously validated questionnaire contained questions on neurosurgeon, patient, and practice characteristics; perceptions of the liability environment; and defensive-medicine behaviors. Bivariate and multivariate analyses examined the state liability risk environment as a predictor of a neurosurgeon's likelihood of practicing defensive medicine.
A total of 1026 neurosurgeons completed the survey (31% response rate). Neurosurgeons' perceptions of their state's liability environment generally corresponded well to more objective measures of state-level liability risk because 83% of respondents correctly identified that they were practicing in a high-risk environment. When controlling for surgeon experience, income, high-risk patient load, liability history, and type of patient insurance, neurosurgeons were 50% more likely to practice defensive medicine in high-risk states compared with low-risk-risk states (odds ratio: 1.5, P<.05).
Both avoidance and assurance behaviors are prevalent among US neurosurgeons and are correlated with subjective and objective measures of state-level liability risk. Defensive medicine practices do not align with patient-centered care and may contribute to increased inefficiency in an already taxed health care system.
由于医疗事故索赔风险高，防御性医疗在美国神经外科医生中很普遍。本研究提供了美国神经外科医生防御行为和认知的全国性估计。
研究防御性医疗（包括“保证”行为和“回避”行为）与责任环境之间的关系。
向美国神经外科医师委员会（ABNS）的3344名美国神经外科医生会员发送了一份包含51个问题的在线调查问卷。该调查为匿名调查，于2011年春季进行，为期6周。先前经过验证的问卷包含有关神经外科医生、患者和执业特征的问题；对责任环境的认知；以及防御性医疗行为。双变量和多变量分析将州责任风险环境作为神经外科医生实施防御性医疗可能性的预测因素进行研究。
共有1026名神经外科医生完成了调查（回复率为31%）。神经外科医生对其所在州责任环境的认知通常与州一级责任风险的更客观衡量标准相符，因为83%的受访者正确识别出他们在高风险环境中执业。在控制外科医生经验、收入、高风险患者负荷、责任历史和患者保险类型后，与低风险州相比，神经外科医生在高风险州实施防御性医疗的可能性高出50%（优势比：1.5，P<.05）。
回避和保证行为在美国神经外科医生中都很普遍，并且与州一级责任风险的主观和客观衡量标准相关。防御性医疗行为与以患者为中心的医疗不一致，可能会导致本已不堪重负的医疗系统效率进一步降低。
