A malpractice fear scale quantifies defensive medicine

Quantifying defensive medicine: Now we have the “malpractice fear scale”
“In evaluating patients who have chest pain, some emergency room physicians too often order unnecessary tests and hospitalizations out of fear of malpractice lawsuits, according to a new study. ‘Concern about malpractice has a formidable effect on physician decision making,’ particularly in the scenario of a possible heart attack or unstable angina, collectively referred to as acute coronary syndrome, Dr. David A. Katz told Reuters Health.

Katz, from University of Iowa, Iowa City, and colleagues developed a malpractice fear scale and used it to evaluate the association between emergency physicians’ fear of malpractice and the evaluation and treatment of patients with symptoms suggestive of an acute coronary syndrome.

The findings are reported in the online issue of Annals of Emergency Medicine.

Patients seen by ER doctors with the highest scores on the malpractice fear scale were significantly less likely to be discharged from the emergency room than were patients seen by ER doctors with the lowest scores, the authors report. The trend persisted when only low-risk patients were included in the analysis.

Physicians with the highest malpractice fear scores were also more likely to admit patients to monitored beds and to order laboratory tests and chest X-rays in the emergency room, the report indicates . . .

. . . ‘Our findings that high-fear physicians are more likely to admit patients with symptoms of possible acute coronary syndrome (including low-risk patients) and to obtain more diagnostic tests in these patients suggest that the initial costs of care are quite a bit higher for this group of physicians.’”

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