Katz Eric D
University of Arizona College of Medicine-Phoenix, Maricopa Integrated Health Systems, Department of Emergency Medicine, Phoenix, Arizona.
Clin Pract Cases Emerg Med. 2019 Oct 21;3(4):329-332. doi: 10.5811/cpcem.2019.9.43975. eCollection 2019 Nov.
Malpractice liability systems exist, in part, to provide compensation for medical malpractice, corrective justice for those injured by it, and to incentivize quality care by punishing substandard care. Defensive medicine is loosely defined as practice based primarily on the fear of litigation rather than on expected patient outcomes. It is largely motivated by a physician's belief that the malpractice system is unfair, slow, and ineffective; these perceptions make malpractice concerns one of the largest physician stressors. A physician's perception of malpractice rarely correlates with the stringency of their state's tort system, overestimates their own risk, and overestimates the cost of defensive practices. While estimates are difficult to make, defensive medicine likely only accounts for 2.8% of total healthcare expenses. The phrase "tort reform" has been frequently used to suggest fixes to the malpractice system and to defensive practices. Safe harbors, clinical practice guidelines, comparative fault reform, reducing plaintiff attorney fees, and apology laws have each been evaluated as potential remedies to defensive practice, although most are unproven and all must be deployed in a state-by-state approach.
医疗事故责任制度的存在，部分目的是为医疗事故提供赔偿，为受其伤害的人提供矫正正义，并通过惩罚不合格的医疗服务来激励高质量的医疗服务。防御性医疗的定义较为宽泛，主要是指基于对诉讼的恐惧而非预期的患者治疗结果而采取的医疗行为。其主要动机是医生认为医疗事故制度不公平、效率低下且效果不佳；这些认知使医疗事故问题成为医生最大的压力源之一。医生对医疗事故的认知很少与所在州侵权制度的严格程度相关，他们高估了自己面临的风险，也高估了防御性医疗行为的成本。虽然很难进行估算，但防御性医疗可能仅占医疗总费用的2.8%。“侵权改革”一词经常被用来暗示对医疗事故制度和防御性医疗行为的改进措施。安全港、临床实践指南、比较过错改革、降低原告律师费以及道歉法等都已被评估为防御性医疗行为的潜在补救措施，不过大多数措施未经证实，而且所有措施都必须以州为单位逐步实施。
