Doctors shame women more than men about their bodies and behavior

By Rachel Feltman
Quartz
Originally published January 16, 2014

Here is an excerpt:

Both studies found that women were significantly more likely to experience these incidents than men were: In the first cohort, which was made up of university students, 26% of women reported being “shamed” by a physician, while only 15% of the men surveyed said the same. The most common topics of this shaming were sex, dental hygiene, and weight. The second study, which included a much broader age and demographic range, showed similar results: While only 38% of men reported feeling guilt or shame because of something their physician said, 53% of women could recall such behavior.

The entire article is here.

Easing Doctor Burnout With Mindfulness

By Pauline Chen
The New York Times
Originally published September 26, 2013

Here is an excerpt:

Research over the last few years has revealed that unrelenting job pressures cause two-thirds of fully trained doctors to experience the emotional, mental and physical exhaustion characteristic of burnout. Health care workers who are burned out are at higher risk for substance abuse, lying, cheating and even suicide. They tend to make more errors and lose their sense of empathy for others. And they are more prone to leave clinical practice.

Unfortunately, relatively little is known about treating burnout. But promising research points to mindfulness, the ability to be fully present and attentive in the moment, as a possible remedy. A few small studies indicate that mindfulness training courses can help doctors become more focused, more empathetic and less emotionally exhausted.

The entire story is here.

Doctors Face New Scrutiny Over Gifts

By Peter Loftus

The Wall Street Journal

Originally published August 22, 2013

U.S. doctors are bracing for increased public scrutiny of the payments and gifts they receive from pharmaceutical and medical-device companies as a result of the new health law.

Starting this month, companies must record nearly every transaction with doctors—from sales reps bearing pizza to compensation for expert advice on research—to comply with the so-called Sunshine Act provision of the U.S. health-care overhaul. The companies must report data on individual doctors and how much they received to a federal health agency, which will post it on a searchable, public website beginning September 2014.

Many doctors say the increased disclosures are making them rethink their relationships with industry, citing concerns about privacy and accuracy, and worry that the public will misinterpret the information. Some fear patients will view the payments as tainting their medical decisions, and will lump together compensation for research-related services with payments of a more promotional nature.

The entire story is here.

Increase in Urine Testing Raises Ethical Questions

By BARRY MEIER
The New York Times
Published: August 1, 2013

As doctors try to ensure their patients do not abuse prescription drugs, they are relying more and more on sophisticated urine-screening tests to learn which drugs patients are taking and — just as important — which ones they’re not.

The result has been a boom in profits for diagnostic testing laboratories that offer the tests. In 2013, sales at such companies are expected to reach $2 billion, up from $800 million in 1990, according to the Frost & Sullivan consulting firm.

The growing use of urine tests has mirrored the rise in prescriptions for narcotic painkillers, or opioids. But the tests, like earlier efforts to monitor opioid prescribing, have led to a host of vexing questions about what doctors should do with the information they obtain, about the accuracy of urine screens and about whether some companies and doctors are financially exploiting the testing boom.

The entire story is here.

It turns out empathy can be taught

By Craig Dowden
Special to Financial Post
Originally published July 7, 2013

There has been increased emphasis on empathy in the field of medicine in recent years. Empathy, it turns out, is directly related to key outcomes of interest to medical observers, including improved patient satisfaction, better patient adherence to proposed treatments, and increased well-being in doctors (including lower burnout). It has also been linked to a reduction in errors by doctors and fewer malpractice claims. As a consequence, the desire to enhance empathy in doctors is not only a noble and laudable goal, but also a valuable one from a bottom-line perspective.

Seeing the profound significance of empathy in medical settings, Dr. Helen Riess, an Associate Clinical Professor of Psychiatry at Harvard Medical School and Director of the Empathy and Relational Science Program at Massachusetts General Hospital, set out to explore whether it was possible to bring about observable improvements in physician empathy. Drawing on Daniel Goleman’s work in the area of emotional intelligence, as well as elements of the neuroscience of empathy, Dr. Riess designed and implemented an empathy training program for physicians.

The entire story is here.

Physician Congressman Fined for Having Sex With 2 Patients

By Robert Lowes
Medscape Medical News
Originally published on May 24, 2014

Rep. Scott DesJarlais, MD (R-TN), was fined $500 by the state medical board in Tennessee for having sexual relationships with 2 female patients in 2000, according to a consent order approved by the board on May 22.

The Board of Medical Examiners of Tennessee also reprimanded Dr. DesJarlais, characterizing his behavior as "unprofessional conduct."

Dr. DesJarlais, a general practitioner who was first elected to represent Tennessee's Fourth Congressional District in 2010, signed the consent order on May 20.

The consent order describes in bare-bones fashion what was laid out in voluminous detail about Dr. DesJarlais' personal life during and after his 2012 reelection campaign. From roughly January 2000 to May 2000, Dr. DesJarlais "had a sexual relationship with 2 female patients," the order states. "No documentation exists to show whether or not the physician-patient relationship was severed prior to the commencement of a romantic relationship with either female patient."

The board fined Dr. DesJarlais $250 for each patient. He also is responsible for the state's cost of prosecuting the case, up to $1000.

The rest of the story is here.

Should I Report My Ex-Wife for Sleeping With Her Patient?

By Chuck Klosterman
The New York Times - The Ethicist
Originally published April 26, 2013

My ex-wife is a physician. We divorced when I found out she was having an affair with one of her H.I.V.-positive patients. I feel compelled to tell the state medical licensing board and the professional societies to which she belongs about her affair. My reasons for doing so are that I feel an intense urge to retaliate her breach of trust and that she potentially exposed me to H.I.V. (fortunately, I tested negative). I also know that, as a physician myself, I should report her to protect other patients, so that she may get increased supervision at her workplace and treatment if needed. Should I report her even though my main motivation is revenge?

The entire article is here.

US sues Novartis in NY again, cites doc kickbacks

By The Associated Press at The Wall Street Journal
Originally published on April 26, 2013

The U.S. government sued Novartis Pharmaceuticals Corp. again on Friday, saying it paid kickbacks for a decade to doctors to steer patients toward its drugs, sometimes disguising fishing trips off the Florida coast and trips to Hooters restaurants as speaking engagements for the doctors.

The lawsuit in U.S. District Court in Manhattan came two days after the government brought a similar lawsuit against Novartis, which is based in East Hanover, N.J.

The first lawsuit said the company paid kickbacks to pharmacies to switch kidney transplant patients from competitors' drugs to its own.

In the second lawsuit, the government accused the company of using from 2001 through 2011 multimillion-dollar "incentive programs" that targeted doctors willing to accept illegal kickbacks to urge patients to use the company's drugs.

"And for its investment, Novartis reaped dramatically increased profits on these drugs, and Medicare, Medicaid and other federal health care programs were left holding the bag," U.S. Attorney Preet Bharara said in a statement.

Novartis President Andre Wyss said the company disagreed with the way the government characterized its conduct and stands behind its compliance program.

The entire story is here.

Antidotes to Burnout: Fostering Physician Resiliency, Well-Being, and Holistic Development

By Herdley O. Paolini, Burt Bertram, & Ted Hamilton
Medscape News
Originally published April 19, 2013

Florida Hospital -- an Orlando-based 8-campus hospital with 2200 beds, a 2000-plus physician medical staff, and more inpatient admissions annually than any other hospital in the United States -- is home to Physician Support Services, a pioneering program created to address physician burnout.

The program provides whole-person care through specialized professional resources aimed at maximizing the personal and professional well-being of Florida Hospital physicians and their families. The direct financial benefit of the program to Florida Hospital is in excess of $5 million over the past 2 years, and the program has rescued the careers of more than 100 physicians in the past 10 years.

The service includes confidential psychotherapy and coaching, continuing medical education (CME) with credit that is focused on helping physicians integrate their personal and professional lives, dialogue programs about cultivating meaning in medical practice, physician leadership development, and marriage retreats.

The Florida Hospital program is based on an in-depth and compassionate understanding of the forces affecting physicians and the practice of medicine, as well as the belief that physician leadership is crucial in envisioning and operationalizing the changes that are needed in the practice of medicine. Rather than ignoring, stigmatizing, or penalizing distressed physicians, Physician Support Services pragmatically addresses the emotional, spiritual, family, and performance issues associated with physician burnout, while intentionally developing physician leadership.

The entire story is here.

Fewer Hours for Doctors-in-Training Leading To More Mistakes

By Alexandra Sifferlin
Time
Originally published March 26, 2013

Giving residents less time on duty and more time to sleep was supposed to lead to fewer medical errors. But the latest research shows that’s not the case. What’s going on?

Since 2011, new regulations restricting the number of continuous hours first-year residents spend on-call cut the time that trainees spend at the hospital during a typical duty session from 24 hours to 16 hours. Excessively long shifts, studies showed, were leading to fatigue and stress that hampered not just the learning process, but the care these doctors provided to patients.

And there were tragic examples of the high cost of this exhausting schedule. In 1984, 18-year old Libby Zion, who was admitted to a New York City hospital with a fever and convulsions, was treated by residents who ordered opiates and restraints when she became agitated and uncooperative. Busy overseeing other patients, the residents didn’t evaluate Zion again until hours later, by which time her fever has soared to 107 degrees and she went into cardiac arrest, and died. The case highlighted the enormous pressures on doctors-in-training, and the need for reform in the way residents were taught. In 1987, a New York state commission limited the number of hours that doctors could train in the hospital to 80 each week, which was less than the 100 hour a week shifts with 36 hour “call” times that were the norm at the time. In 2003, the Accreditation Council for Graduate Medical Education followed suit with rules for all programs that mandated that trainees could work no more than 24 consecutive hours.

The entire article is here.

Familiarity breeds doctor contempt with EHRs

Experts say meaningful use is contributing to the growth of electronic health record systems, but it also has a negative effect on EHR user-friendliness.

By Pamela Lewis Dolan
amednews.com
Originally published March 18, 2013

The meaningful use incentive program has resulted in more physicians implementing electronic health record systems and using them in advanced ways. Yet doctors' dissatisfaction with the systems has increased.

Theories for what is driving the dissatisfaction include rushed implementations, too little training and physicians doing too much too soon as they struggle to meet meaningful use requirements, other federal mandates and changes to the health care landscape. EHR vendors also are thought to be taking on too much in too little time. As they rush to deliver products certified for meaningful use, usability may have suffered.

A survey by AmericanEHR Partners of 4,279 clinicians, including primary care physicians, specialists and diagnostic professionals, found that user satisfaction declined from 39% in 2010 to 27% in 2012. The rate of those “very dissatisfied” increased from 11% to 21% during the same period. The findings were presented in March at the Healthcare Information and Management Systems Society annual conference in New Orleans.

The entire article is here.

Why Failing Med Students Don’t Get Failing Grades

By Pauline Chen
The New York Times
Originally published February 28, 2013

Here are some excerpts:

Medical educators have long understood that good doctoring, like ducks, elephants and obscenity, is easy to recognize but difficult to quantify. And nowhere is the need to catalog those qualities more explicit, and charged, than in the third year of medical school, when students leave the lecture halls and begin to work with patients and other clinicians in specialty-based courses referred to as “clerkships.” In these clerkships, students are evaluated by senior doctors and ranked on their nascent doctoring skills, with the highest-ranking students going on to the most competitive training programs and jobs.

A student’s performance at this early stage, the traditional thinking went, would be predictive of how good a doctor she or he would eventually become.

But in the mid-1990s, a group of researchers decided to examine grading criteria and asked directors of internal medicine clerkship courses across the country how accurate and consistent they believed their grading to be.

The entire story is here.

Assisted Suicide on Legal Agenda in Several States

By Susan Haigh
Associated Press
Originally posted February 8, 2013

A push for the legalization of physician-assisted suicide is under way in a half-dozen states where proponents say they see strong support for allowing doctors to prescribe mentally competent, dying individuals with the medications needed to end their own lives.

The large number of baby boomers facing end-of-life issues themselves is seen to have made the issue more prominent in recent years. Groups such as Compassion & Choices, a national end-of-life advocacy organization, have been working to advance the cause.

Advocates received a boost from last year's ballot question in Massachusetts on whether to allow physicians to help the terminally ill die. Although the vote failed, it helped to spark a national discussion, said Mickey MacIntyre, chief program officer for Compassion & Choices.

"The Massachusetts initiative lifted the consciousness of the nation and in particular the Northeast region to this issue that there are other alternatives patients and their families should have an opportunity to access," MacIntyre said.

Bills legalizing assisted suicide are being considered in Connecticut, Vermont, New Jersey, Kansas and Hawaii — and in Massachusetts, where proponents decided to resume their efforts after the public vote, according to the National Conference of State Legislatures, which tracks legislative trends. There are also bills related to the issue under consideration in New Hampshire, New York, Arizona and Montana.

In Connecticut, which has banned the practice since 1969, a group of lawmakers said Tuesday that the legislature's first public hearing on the subject would probably be held this month. At least two bills on the issue have so far been proposed in this year's session of the Connecticut legislature.

The entire story is here.

Details on suicide among US physicians: data from the National Violent Death Reporting System

By Karen Gold, Ananda Sen, and Thomas Schwenk
General Hospital Psychiatry
Volume 35, Issue 1 , Pages 45-49, January 2013

Abstract 
Objective
Physician suicide is an important public health problem as the rate of suicide is higher among physicians than the general population. Unfortunately, few studies have evaluated information about mental health comorbidities and psychosocial stressors which may contribute to physician suicide. We sought to evaluate these factors among physicians versus non-physician suicide victims.

Methods
We used data from the United States National Violent Death Reporting System to evaluate demographics, mental health variables, recent stressors and suicide methods among physician versus non-physician suicide victims in 17 states.

Results
The data set included 31,636 suicide victims of whom 203 were identified as physicians. Multivariable logistic regression found that having a known mental health disorder or a job problem which contributed to the suicide significantly predicted being a physician. Physicians were significantly more likely than non-physicians to have antipsychotics, benzodiazepines and barbiturates present on toxicology testing but not antidepressants.

Conclusions
Mental illness is an important comorbidity for physicians who complete a suicide but postmortem toxicology data shows low rates of medication treatment. Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.

The entire article is here.

Thanks to Ed Zuckerman for this article.

Physician Suicide Linked to Work Stress

By Crystal Phend, Senior Staff Writer
MedPage Today
Originally published November 14, 2012

Suicide among physicians appears to follow a different profile than in the general population, with a greater role played by job stress and mental health problems, a national analysis showed.

Problems with work were three times more likely to have contributed to a physician's suicide than a nonphysician's, Katherine J. Gold, MD, MSW, of the University of Michigan in Ann Arbor, and colleagues found.

Their analysis of the National Violent Death Reporting System also showed that known mental illness prior to suicide was 34% more common among physicians than nonphysicians.

"The results of this study paint a picture of the typical physician suicide victim that is substantially different from that of the nonphysician suicide victim in several important ways," the group wrote online in General Hospital Psychiatry.

The entire story is here.

The original article is here.

Here is the conclusion from the abstract:

Mental illness is an important comorbidity for physicians who complete a suicide but postmortem toxicology data shows low rates of medication treatment. Inadequate treatment and increased problems related to job stress may be potentially modifiable risk factors to reduce suicidal death among physicians.

Stressed physicians reluctant to seek support

They cite lack of time and fear of hurting their careers as reasons to avoid employee-assistance programs.

By KEVIN B. O'REILLY, amednews staff

Nearly 80% of physicians at an academic medical center said they experienced a personal crisis within the past year, yet most said they would not seek support from physician-health services or employee-assistance programs.

The 108 surgeons, anesthesiologists and emergency physicians surveyed said they experienced a wide range of stressful events, such as serious illnesses or deaths in their families and severe adverse events in their patients. But most they said they were unlikely to turn to institutional sources of support, with 40% saying they would be willing to consult physician-health services and 29% open to using employee-assistance programs. About a third of the doctors had never even heard of these services, said an Archives of Surgery study published in March.

The reason offered most frequently for not getting help was lack of time, with 90% of the physicians surveyed at Brigham and Women’s Hospital in Boston citing it. About 70% feared a lack of confidentiality, negative impact on their careers or the stigma of mental illness. Nearly half feared legal consequences or thought “using services means I am weak.”

The entire story is here.

The original abstract is here.

Suspended Nova Scotia doctor may get licence back

CBC News.
Former patient blames doctor for suicide

A Nova Scotia doctor who used a patient to get a narcotic drug for her personal use will be allowed to return to the practice of medicine if she fulfils several conditions imposed by the College of Physicians and Surgeons of Nova Scotia.

Dr. Violet Hawes of Middle Musquodoboit had her licence suspended in November 2009 after the allegations surfaced.

The following month, one of her former patients committed suicide and left a note blaming her.
Doug Carpenter, 49, took his life in the parking lot of the Musquodoboit Valley Memorial Hospital in December 2009.

He left a note for his family saying "Dr. Hawes did this to me."

According to Carpenter's medical records, Hawes prescribed him Hydromorph Contin — a narcotic — for the first time in January 2008.

Carpenter's mother, Phyllis, said her son had described an arrangement with his doctor when she prescribed the drug.

"She would have a prescription ready for him when he went in there for his drug. He would fill it and give it to her," Carpenter told CBC News last December.

The entire CBCNews-Canada story can be here.

There was a similar case in central Pennsylvania in which a physician used numerous patients to obtain narcotics for himself.  In the Pennsylvania case, the physician's patient did not commit suicide, but he apparently told patients the drugs were for a dying parent.  Physicians using patient to obtain narcotics occurs.

Some of that information can be found here.

Petitioner was charged with five misdemeanor counts of unlawful procurement of prescription drugs in violation of 63 P.S. � 390-8(13) - however, the misdemeanor conviction is not at issue in this proceeding. Both the felony and misdemeanor charges involved Hydrocodone (Lortab) a Schedule III controlled substance. I.G. Ex. 8, at 1.

Nearly all U.S. doctors are now on social media

By Pamela Lewis Dolan
amedness.com

The number of physicians using sites such as Facebook and Twitter has grown so quickly that Gabriel Bosslet, MD, realized the moment his study on physician social media use appeared in June that it already was out of date.

The data, collected by Dr. Bosslet between February and May 2010 and posted more than a year later on the Journal of General Internal Medicine site, found that 41.6% of doctors use social media sites.

However, between April and May 2011, research and consulting firm Frost & Sullivan found that 84% of doctors use social media for personal purposes. Then in August, nearly 90% of physicians reported that they used at least one social media site personally, according to a survey by the online physician learning collaborative QuantiaMD.

By those numbers, physicians are well ahead of the general adult population -- 65% of the general public use social media, according to a study published in August by the Pew Internet & American Life Project.

"The rise in social media has been so meteoric," said Dr. Bosslet, an internist at Indiana University Health and an affiliate faculty member at the Charles Warren Fairbanks Center for Medical Ethics in Indianapolis, which sponsored his research. The time that passed between data collection to his study's results being posted was like a "generation later," he said.

However, although physicians appear to be embracing social media, they are still feeling their way around it. According to QuantiaMD, 87% of physicians make personal use of social media, but a lesser amount, 67%, use it professionally. And one thing that hasn't changed during those 18 months is the lack of patient-physician communication on social media.

One-third of the QuantiaMD survey respondents said they had received a friend request from a patient on Facebook. Three-quarters of the physicians declined those invitations.

"There is a real reticence on the part of many physicians to use social media, or even email for that matter, to communicate with patients," said Nancy Fabozzi, health care market research and competitive intelligence specialist with Frost & Sullivan. Not only are physicians worried about liability and privacy issues, but also "there's not enough hours in the day, quite frankly," she said.

The entire story can be found here.

When Physicians Treat Members of Their Own Families

By J.L. Puma, C. B. Stocking, D. LaVoie, and
C.A. Carling

New England Journal of Medicine, October 31, 1991

STORIES have been told about physicians who treat their own family members, but to the best of our knowledge, this practice has not been studied. Family members may benefit; they may avoid the inconvenience and expense of an office visit and gain an especially caring, available expert who is able to interpret medical language and help them maneuver through medical systems. Physicians may also benefit; accustomed to caring for patients and surrounded by books, tools, and pharmaceuticals, they may consider attending to ill family members a natural and rewarding opportunity.

Ethical questions have been raised, however, about physicians who treat members of their own families. McSherry found incomplete physical examinations, medical records, and immunizations to be undesirable consequences of physicians' treating their own children.1 The 1901 code of ethics of the American Medical Association (AMA) noted that a family member's illness "tends to obscure [the physician's] judgement and produce timidity and irresolution in his practice."2 In 1977, a revised admonition was dropped by the AMA with other "outmoded matters of medical etiquette."3In 1989, fearing financial abuse by unscrupulous providers, Medicare barred payment to physicians who care for "immediate family members."4

In this study, in an attempt to understand current practice, we asked these questions: Which family members request advice, diagnosis, or treatment? How do physicians respond to such requests? Which, if any, requests make physicians feel uncomfortable? And under what circumstances do physicians refuse requests from family members for medical assistance?

(Jump to the discussion)

DISCUSSION

To understand current norms, we gathered empirical data on which family members ask physicians for advice, diagnosis, or treatment and how physicians respond to these requests. We also attempted to understand the dilemmas inherent in this practice. In general, physicians reported providing services to relatives in proportion to how often and by whom they were asked.

Family Members' Requests

The services family members request and the services their physician relatives offer are probably different. Family members may request care that requires a complete history and physical examination, new knowledge, or facilities that are unavailable, thus sometimes embarrassing and frustrating their physician relatives. Conversely, many young children are simply given medical care by their parents. Although most respondents reported requests from their children, we did not distinguish among children's own requests, another parent's requests for them, and the physician parent's own wish to provide care.

Physicians' Responses

Caring for family members has advantages for patients with minor illnesses, especially when the physician is in primary care, although advantages for patients near the end of life have also been described.5 Recurrent problems such as conjunctivitis and pediatric pharyngitis are usually minor, have predictable courses, and may seem too trivial to trouble an unrelated doctor about. For all patients, our medical—financial complex is best negotiated by a strong patient advocate, conveniently located and readily accessible, who is both altruistic and self-interested.

The most important diagnoses physicians gave to family members ranged from trivial to grave. The breadth of these diagnoses and the relatively narrow range of operations performed suggest that personal, psychological, and familial factors contributed to the assessment of "most important." It is uncertain whether respondents made these diagnoses informally, as knowledgeable spouses (for example, a wife asks her physician husband about a breast lump she has found, which he then palpates), or formally, as attending physicians (a physician daughter takes her father's blood pressure regularly, reviewing his age, diet, weight, medications, electrocardiogram, and family history).

Sources of Discomfort

The central reason for physicians' refusal of and discomfort with requests appears to be missing medical information. About a third of the respondents mentioned colleagues who appeared to be inappropriately involved in the care of family members, describing the care provided as inadequate or contraindicated or reporting the obstruction of other providers' care. Respondents inferred that this poor quality of care resulted from their colleagues' closeness to the patient, but this inference may be scientifically unjustified. Comparative process and outcome evaluations of care provided to patients who are family members and to those who are not would permit a more complete assessment of the quality of care.

Our data suggest that along with limiting their active participation, physicians attempt to limit their emotional involvement in family members' care. Setting limits may reflect physicians' recognition of the emotional complexity of having dual roles,6 physicians' difficulty in providing reassurance when a serious illness is suspected,2 or the problems anticipated when there is a family relationship instead of a potentially therapeutic doctor–patient relationship.

The entire article can be read here.

Thanks to Gary Schoener for this information.  Our Ethics Committee is currently working on a vignette that relates to this article.

Malpractice Risk According to Physician Specialty

Blog Editor Note:

According to this study, only 1 in 5 malpractice claims against doctors leads to a settlement or other payout. While doctors and their insurers may be winning most of these lawsuits, there still remains a high amount of legal actions in medicine. This study indicates that, each year, about 1 in 14 doctors is the target of a claim, and most physicians and virtually every surgeon will face at least one in their careers. While these numbers may support those who believe there are a high number of frivolous lawsuits, the authors seek to understand the complexity of these issues.  Also, psychiatrists have one of the lowest lawsuit rates of the medical specialities and one of the lowest number of payouts.

------------------------------

Anupam B. Jena, M.D., Ph.D., Seth Seabury, Ph.D., Darius Lakdawalla, Ph.D., and Amitabh Chandra, Ph.D.

The New England Journal of Medicine

Abstract


Despite tremendous interest in medical malpractice and its reform, data are lacking on the proportion of physicians who face malpractice claims according to physician specialty, the size of payments according to specialty, and the cumulative incidence of being sued during the course of a physician's career. A recent American Medical Association (AMA) survey of physicians showed that 5% of respondents had faced a malpractice claim during the previous year. Studies estimating specialty-specific malpractice risk from actual claims are much less recent, including a Florida study from 1975 through 1980 showing that 15% of medical specialists, 34% of obstetricians and anesthesiologists, and 48% of surgical specialists faced at least one claim that resulted in an associated defense cost or payment to a claimant (an indemnity payment) during the 6-year study period.

Each of these earlier studies has limitations, including the use of older data with limited geographic coverage, reliance on self-reports with limited sample size and low response rates, limited information on physician specialty, and a lack of information on the size of payments. Although the National Practitioner Data Bank includes most cases in the United States in which a plaintiff was paid on behalf of a licensed health care provider, it does not report the specialties of physicians and does not record information on cases that do not result in a payment.

Using physician-level malpractice claims obtained from a large professional liability insurer, we characterized three aspects of malpractice risk among physicians in 25 specialties: the proportion of physicians facing a malpractice claim in a given year, the proportion of physicians making an indemnity payment, and the size of this payment. In addition, we estimated the cumulative career risk of facing a malpractice claim for physicians in high- and low-risk specialties.

Part of the Discussion Section

Our results may speak to why physicians consistently report concern over malpractice and the intense pressure to practice defensive medicine, despite evidence that the scope of defensive medicine is modest. Concern among physicians over malpractice risk varies far less considerably across states than do objective measures of malpractice risk according to state (e.g., rates of paid claims, average payment sizes, malpractice premiums, and state tort reforms). For example, 65% of physicians practicing in states in the bottom third of rates for paid malpractice claims (5.5 paid claims per 1000 physicians) express substantial concern over malpractice, as compared with 67% of physicians in the top third (14.6 claims per 1000 physicians). Although these annual rates of paid claims are low, the annual and career risks of any malpractice claim are high, suggesting that the risk of being sued alone may create a tangible fear among physicians.

The perceived threat of malpractice among physicians may boil down to three factors: the risk of a claim, the probability of a claim leading to a payment, and the size of payment. Although the frequency and average size of paid claims may not fully explain perceptions among physicians, one may speculate that the large number of claims that do not lead to payment may shape perceived malpractice risk. Physicians can insure against indemnity payments through malpractice insurance, but they cannot insure against the indirect costs of litigation, such as time, stress, added work, and reputational damage.  Although there is no evidence on the size of these indirect costs, direct costs are large. For example, a Harvard study of medical malpractice suggested that nearly 40% of claims were not associated with medical errors and that although a low percentage of such claims led to payment of compensation (28%, as compared with 73% of claims with documented medical errors), they accounted for 16% of total liability costs in the system.

The entire article can be read here.