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ABSTRACT
Objectives: "Assurance behaviors" in medical practice involve providing additional services of marginal or no medical value to avoid adverse outcomes, deter patients from filing malpractice claims, or ensure that legal standards of care were met. The extent to which concerns about medical malpractice influence assurance behaviors of pathologists interpreting breast specimens is unknown.
Methods: Breast pathologists (n = 252) enrolled in a nationwide study completed an online survey of attitudes regarding malpractice and perceived alterations in interpretive behavior due to concerns of malpractice. Associations between pathologist characteristics and the impact of malpractice concerns on personal and colleagues' assurance behaviors were determined by χ2 and logistic regression analysis.
Results: Most participants reported using one or more assurance behaviors due to concerns about medical malpractice for both their personal (88%) and colleagues' (88%) practices, including ordering additional stains, recommending additional surgical sampling, obtaining second reviews, or choosing the more severe diagnosis for borderline cases. Nervousness over breast pathology was positively associated with assurance behavior and remained statistically significant in a multivariable logistic regression model (odds ratio, 2.5; 95% confidence interval, 1.0-6.1; P = .043).
Conclusions: Practicing US breast pathologists report exercising defensive medicine by using assurance behaviors due to malpractice concerns.
Key Words: Medical malpractice; Defensive medicine; Assurance behaviors; Breast pathology; Breast
Delayed diagnosis of breast cancer is a leading cause of malpractice suits filed in the United States,1,2 and malpractice litigation is least likely to be dismissed and most likely to go to trial when a pathologist is involved compared with malpractice litigation involving other medical specialties.3 A recent analysis of malpractice claims from a large professional liability insurer indicated that the average indemnity payment for pathologists was higher than high-risk specialties such as neurosurgery.4 Although pathology claim frequency is low, pathology claim severity is high, particularly with claims involving failure to diagnose cancer, resulting in delayed diagnosis or inappropriate treatment.5
Defensive medicine is defined as a deviation from standard medical practice induced primarily by a threat of liability.6 More specifically, physicians order additional services with marginal or no medical value to avoid adverse patient outcomes, deter patients from filing malpractice claims, or ensure that legal standards of care are met.7,8 Such behaviors are known as assurance behaviors. A 2009 nationwide survey of...