Contradicting prior research connecting heavy ordering of diagnostic exams with fear of malpractice charges—aka “defensive medicine”—a new survey shows ED referrers more focused on not harming patients than on not getting sued.
The findings are presented in a brief research letter published Nov. 10 in JAMA Network Open [1].
Psychologist Linda Isbell, PhD, of the University of Massachusetts and colleagues received survey responses from 1,222 emergency-medicine clinicians (782 physicians and 340 advanced practice clinicians) working across the Bay State.
The survey asked participants to indicate their degree of agreement on a scale of 1 (strongly disagree) to 6 (strongly agree) with two statements:
- In my day-to-day practice, I am fearful of making a mistake that results in 1.) harm to the patient and 2.) my being sued.
Analyzing the results, Isbell and co-researchers found mean Likert score was greater for fear of patient harm (4.40) than fear of malpractice or negligence lawsuit (3.40).
This held regardless of clinician subtype, years of experience and female vs. male.
The authors note the relevance of these findings to discussions of defensive medicine.
Moreover, the team found no difference in mean fear-of-suit score before vs. after the start of the COVID-19 pandemic (3.41 vs. 3.38, respectively).
Isbell and co-authors cite prior research identifying fear of lawsuits as a primary driver behind excessive ordering of diagnostic tests, including imaging exams.
Although the present study did not delineate an association between fear of harm and potential overuse of testing, they write, it suggests that “fear of harm should be considered with, and may be more consequential than, fear of suit in medical decision-making.”
The authors acknowledge limitations in their study design, including a survey sample from a single state.
“Additional research is needed to elucidate the role of fear of harm compared with fear of suit in clinician decision-making,” they write.
The letter is available in full for free.
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.