Gadjradj Pravesh S, Ghobrial Julian B, Harhangi Biswadjiet S
1Department of Neurosurgery, Leiden University Medical Center, University Neurosurgical Center Holland (UNCH), Leiden; and.
2Department of Neurosurgery, Erasmus MC: University Medical Center Rotterdam, The Netherlands.
Neurosurg Focus. 2020 Nov;49(5):E3. doi: 10.3171/2020.8.FOCUS20250.
As a specialty that treats acute pathology and refractory pain, neurosurgery is at risk for high liability, making the practice of defensive medicine quite common. The extent to which the practice of defensive medicine is linked to experience with malpractice lawsuits remains unclear. The aims of this study were to clarify this by surveying neurosurgeons about the frequency of experiencing medical lawsuits and to show how neurosurgeons reflect on facing such lawsuits.
A survey consisting of 24 questions was distributed among members of the Congress of Neurological Surgeons. The survey consisted of four parts: 1) demographics of participants; 2) the way malpractice lawsuits affect the way respondents practice medicine; 3) experiences with medical malpractice lawsuits; and 4) the effect of the medical malpractice environment on one's own practice of medicine.
There were a total of 490 survey respondents, 83.5% of whom were employed in the US. Of the respondents, 39.5% stated they were frequently or always concerned about being sued, and 77.4% stated their fear had led to a change in how they practice medicine. For 58.4%, this change led to the practice of defensive medicine, while for others it led to more extensive documentation (14.3%) and/or to referring or dropping complex cases (12.4%).Among the respondents, 80.9% at some time were named in a medical malpractice lawsuit and 12.3% more than 10 times. The main concerns expressed about being sued included losing confidence and practicing defensive medicine (17.8%), personal assets being at risk (16.9%), and being named in the National Practitioner Data Bank (15.6%). Given the medical malpractice environment, 58.7% of respondents considered referring complex patient cases, whereas 36.5% considered leaving the practice of medicine. The fear of being sued (OR 4.06, 95% CI 2.53-6.51) and the consideration of limiting the scope of practice (OR 3.08, 1.80-5.20) were both independently associated with higher odds of considering leaving the practice of medicine.
The current medicolegal landscape has a profound impact on neurosurgical practice. The fear of being sued, the financial aspects of practicing defensive medicine, and the proportion of neurosurgeons who are considering leaving the practice of medicine emphasize the need for a shift in the medicolegal landscape to a system in which fear of being sued does not play a dominant role and the interests of patients are protected.
作为一门治疗急性病症和顽固性疼痛的专业学科，神经外科面临着较高的责任风险，这使得防御性医疗行为相当普遍。防御性医疗行为与医疗事故诉讼经历之间的关联程度尚不清楚。本研究的目的是通过调查神经外科医生经历医疗诉讼的频率来阐明这一点，并展示神经外科医生如何看待面临此类诉讼。
向神经外科医师大会的成员发放了一份包含24个问题的调查问卷。该调查包括四个部分：1）参与者的人口统计学信息；2）医疗事故诉讼对受访者行医方式的影响；3）医疗事故诉讼经历；4）医疗事故环境对自身行医的影响。
共有490名受访者，其中83.5%受雇于美国。在受访者中，39.5%表示他们经常或总是担心被起诉，77.4%表示这种担忧导致他们改变了行医方式。对于58.4%的人来说，这种改变导致了防御性医疗行为，而对其他人来说，导致了更广泛的记录（14.3%）和/或转诊或放弃复杂病例（12.4%）。在受访者中，80.9%曾在某个时候被卷入医疗事故诉讼，12.3%被卷入超过10次。对被起诉表示的主要担忧包括失去信心和采取防御性医疗行为（17.8%）、个人资产面临风险（16.9%）以及被列入国家从业者数据库（15.6%）。鉴于医疗事故环境，58.7%的受访者考虑转诊复杂的患者病例，而36.5%的受访者考虑放弃行医。担心被起诉（比值比4.06，95%置信区间2.53 - 6.51）和考虑限制行医范围（比值比3.08，1.80 - 5.20）均与考虑放弃行医的较高几率独立相关。
当前的法医学环境对神经外科实践有深远影响。对被起诉的恐惧、防御性医疗行为的财务方面以及考虑放弃行医的神经外科医生比例强调了法医学环境需要转向一种体系，在该体系中，对被起诉的恐惧不占主导地位，且患者利益得到保护。
