PHYSICIANS PERSONAL MALPRACTICE EXPERIENCES ARE NOT RELATED TO DEFENSIVE CLINICAL PRACTICES

Whether personal malpractice experience is part of a tort signal promp ting physicians to practice defensively is unclear. To explore this is sue further, we assessed how physicians' malpractice experiences affec t clinical decision making. We surveyed 1,540 physicians from four spe cialty groups (cardiologists, surgeons, obstetrician-gynecologists, an d internists) using specialty-specific clinical scenarios. Physicians were in active private practice, were covered by a single malpractice insurer for five or more years, and worked in an eastern state. The ne t response rate was 54 percent (835 of 1,540) but measurable bias, bas ed on practice characteristics, was negligible. Physicians evaluated c linical scenarios that were designed to maximize potential for finding positive defensive practices (extra tests and procedures). Then they rated how various factors influenced their decisions and answered ques tions on practice attitudes. The study compared management and testing recommendations among physicians with varying levels of malpractice e xposure, which we defined in three separate ways. Participants were un aware of the study hypotheses. Physicians with greater malpractice exp erience showed no systematic differences in initial management choice or subsequent test recommendations. For example, similar percentages o f internists in the top and bottom claims rate quartiles admitted a pa tient with syncope (78 percent versus 73 percent; p = .42), discharged a patient with nonspecific chest pain (80 percent versus 80 percent; p = .88), and delayed surgery in a patient with nonspecific changes on a electrocardiograph (58 percent versus 68 percent; p = .18). Attitud es about malpractice also did not differ with varying malpractice expe rience. Personal malpractice experience is not a predominant factor in the tort signal that prompts physicians to engage in defensive practi ces, to the extent that such practices exist.