Malpractice Concerns, Defensive Medicine, and the Histopathology Diagnosis of Melanocytic Skin Lesions
Year: 2018
Type: article
Study design: Observational Study
Abstract: OBJECTIVES: The impact of malpractice concerns on pathologists' use of defensive medicine and interpretations of melanocytic skin lesions (MSLs) is unknown. METHODS: A total of 207 pathologists interpreting MSLs responded to a survey about past involvement in malpractice litigation, influence of malpractice concerns on diagnosis, and use of assurance behaviors (defensive medicine) to alleviate malpractice concerns. Assurance behaviors included requesting second opinions, additional slides, additional sampling, and ordering specialized tests. RESULTS: Of the pathologists, 27.5% reported that malpractice concerns influenced them toward a more severe MSL diagnosis. Nearly all (95.2%) pathologists reported practicing at least one assurance behavior due to malpractice concerns, and this practice was associated with being influenced toward a more severe MSL diagnosis (odds ratio, 2.72; 95% confidence interval, 1.41-5.26). CONCLUSIONS: One of four US skin pathologists upgrade MSL diagnosis due to malpractice concerns, and nearly all practice assurance behaviors. Assurance behaviors are associated with rendering a more severe MSL diagnosis.
DOI: 10.1093/ajcp/aqy057
Institutions: Dartmouth College, Dartmouth Institute for Health Policy and Clinical Practice, Oregon Health & Science University, Université Paris Sciences et Lettres, Université Paris Descartes, Institut Curie, Hospital of the University of Pennsylvania, University of Pennsylvania, Brown University, Rhode Island Hospital, Providence VA Medical Center, University of Washington, University of California, Los Angeles
Language: English
Subfield: Pharmacy
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
Funder: National Cancer Institute
OpenAlex ID: W2856892759