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. 2020 Oct 13;154(5):700-707.
doi: 10.1093/ajcp/aqaa088.

Malpractice and Patient Safety Concerns

Lisa M Reisch  1 , Martiniano J Flores  2 , Andrea C Radick  1 , Hannah L Shucard  1 , Kathleen F Kerr  1 , Michael W Piepkorn  3   4 , Raymond L Barnhill  5 , David E Elder  6 , Stevan R Knezevich  7 , Joann G Elmore  8
Affiliations

Malpractice and Patient Safety Concerns

Lisa M Reisch et al. Am J Clin Pathol. .

Abstract

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.

Keywords: Assurance behaviors; Defensive medicine; Dermatopathology; Medical malpractice; Melanocytic skin lesions; Patient harm; Patient safety.

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Figures

Figure 1
Figure 1
Reducing Errors in Melanocytic Interpretations (REMI) online survey questions regarding medical malpractice and patient safety concerns.
Figure 2
Figure 2
Percentage of pathologists who agree with statements that they engage in clinical behaviors due to malpractice concerns and patient safety concerns. Asterisk indicates statistically significant differences between malpractice concerns and patient safety concerns on clinical behavior. Black bars indicate 95% confidence intervals for proportion. IHC, immunohistochemistry.
Figure 3
Figure 3
Likert scale responses to clinical behaviors due to malpractice concerns and patient safety concerns (strongly disagree to strongly agree). IHC, immunohistochemistry.
See this image and copyright information in PMC

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