医疗事故和患者安全问题。
Malpractice and Patient Safety Concerns.
机构信息
Department of Biostatistics, University of Washington, Seattle.
Edwards Lifesciences, Irvine, CA.
出版信息
Am J Clin Pathol. 2020 Oct 13;154(5):700-707. doi: 10.1093/ajcp/aqaa088.
OBJECTIVES
"Assurance behaviors," a type of defensive medicine, involve physicians' utilization of additional patient services to avoid adverse legal outcomes. We aim to compare the use of clinical behaviors (such as ordering additional tests, services, and consultations) due to malpractice concerns with the same behaviors due to patient safety concerns.
METHODS
A national sample of dermatopathologists (n = 160) completed an online survey.
RESULTS
Participants reported using one or more of five clinical behaviors due to concerns about medical malpractice (95%) and patient safety (99%). Self-reported use of clinical behaviors due to malpractice concerns and patient safety concerns was compared, including ordering additional immunohistochemistry/molecular tests (71% vs 90%, respectively, P < .0001), recommending additional surgical sampling (78% vs 91%, P < .0001), requesting additional slides (81% vs 95%, P < .0001), obtaining second reviews (78% vs 91%, P < .0001), and adding caveats into reports regarding lesion difficulty (85% vs 89%, P > .05).
CONCLUSIONS
Dermatopathologists use many clinical behaviors both as assurance behaviors and due to patient safety concerns, with a higher proportion reporting patient safety concerns as a motivation for specific behaviors.
目的
“保证行为”是一种防御性医疗行为，涉及医生利用额外的患者服务来避免不利的法律后果。我们旨在比较因医疗事故担忧而使用的临床行为（如额外的检查、服务和咨询）与因患者安全担忧而使用的相同行为。
方法
一项全国性的皮肤科病理学家（n=160）的在线调查。
结果
参与者报告因医疗事故（95%）和患者安全（99%）的担忧而使用了一种或多种五种临床行为。比较了因医疗事故担忧和患者安全担忧而自我报告的临床行为的使用，包括额外的免疫组织化学/分子测试（分别为 71%和 90%，P<0.0001）、推荐额外的手术取样（分别为 78%和 91%，P<0.0001）、要求额外的切片（分别为 81%和 95%，P<0.0001）、获得第二意见（分别为 78%和 91%，P<0.0001），以及在报告中增加关于病变难度的警告（分别为 85%和 89%，P>0.05）。
结论
皮肤科病理学家既出于保证行为，也出于患者安全考虑而使用许多临床行为，报告因患者安全担忧而使用特定行为的比例更高。
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