Abstract
Purpose
Defensive Medicine occurs when doctors order tests, procedures, visits or avoid high-risk patients and procedures, primarily to reduce their exposure to malpractice liability. Some medical specialities are at “high-risk” for legal argument, but no data is actually available for radiation oncology. We present here the first survey of radiation oncologists’ views regarding malpractice liability and defensive medicine practice.
Materials and methods
A three-page questionnaire was sent to 611 active radiation oncologists, members of the Italian Association of Radiation Oncology (AIRO), with questions pertaining to the incidence, nature and causes in their practice of defensive medicine.
Results
A total of 361 questionnaires were completed (59 % feedback). Physicians practise defensive medicine by ordering further imaging studies (39 %) or laboratory tests (35 %), referring patients to consultants (43 %) or prescribing additional medication (35 %). Approximately, 70 % declared that the climate of opinion that exists towards doctors is one of the major issues for practising defensive medicine.
Conclusion
Although radiation oncology is generally considered a “medium/low risk” speciality for defensive medicine, the present survey reflects a widespread use of this behaviour in daily practice. Investigating which radiation oncologist categories are more prone to defensive medical behaviour can be advantageous for implementing programmes aimed at improving awareness of this phenomenon and to increase good clinical practice.
Similar content being viewed by others
References
US Congress; Office of Technology Assessment (1994). Defensive medicine and medical malpractice. US Government Printing Office, Washington, DC (publication OTA-H-602)
Hershey N (1972) The defensive practice of medicine: myth or reality. Milbank Mem Fund Q 50:69–98
Veldhuis M (1994) Defensive behavior of Dutch family physicians: widening the concept. Fam Med 26:27–29
Summerton N (1995) Positive and negative factors in defensive medicine. Brit Med J 310:27–29
Coyte PC, Dewees DN, Trebilcock MJ (1991) Medical malpractice. N Engl J Med 324:89–93
Kessler D, McClellan M (1996) Do doctors practice defensive medicine? Q J Econ 111:353–390
ANIA, L’associazione delle Imprese Assicurative (2009). http://www.ania.it/. Accessed Sept 2013
Manner P (2007) AAO. http://www.aaos.org/news/bulletin/janfeb07/clinical2.asp. Jan/Feb 2007
Studdert DM, Mello MM, Sage WM et al (2005) Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 293:2609–2617
Katz DA, Williams GC, Brown RL et al (2005) Emergency physicians’ fear of malpractice in evaluating patients with possible acute cardiac ischemia. Ann Emerg Med 46:525–533
Sethi MK, Obremskey WT, Natividad H et al (2012) Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Am J Orthop (Belle Mead NJ) 41:69–73
Anderson BL, Strunk AL, Schulkin J (2011) Study on defensive medicine practices among obstetricians and gynecologists who provide breast care. J Healthc Qual 33:37–43
Nahed BV, Babu MA, Smith TR et al (2012) Malpractice liability and defensive medicine: a national survey of neurosurgeons. PLoS One 7(6):e39237
Piperno A (2010) I dati della prima ricerca nazionale sulla medicina difensiva, Senato della Repubblica, http://www.quotidianosanita.it/allegati/allegato9848861.pdf. Accessed Sept 2013
Forti G, Catino M, Cattorini P et al (2008) Il problema della medicina difensiva: una proposta di riforma, a cura del CSGP, http://www.sichirurgia.org/index.asp?cat=67&menu=MEditoria.asp. Accessed Sept 2013
Rubin RJ, Mendelson DN (1994) How much does defensive medicine cost? J Am Health Policy 4:7–15
The Factors Fueling Rising Healthcare Costs (2006) Prepared for America’s Health Insurance Plans, Price Waterhouse Coopers. America’s Health Insurance Plans, 2006. http://www.liberatehealthcare.com/trends_costs/The%20Factors%20Fueling%20Rising%20Healthcare%20Costs.pdf. Accessed Sept 2013
Hellinger FJ, Encinosa WE (2006) The impact of state laws limiting malpractice damage awards on health care expenditures. Am J Public Health 96:1375–1381
Conflict of interest
Dr Sara Ramella has no conflict of interest to declare. Dr Giovanni Mandoliti has no conflict of interest to declare. Prof Lucio Trodella has no conflict of interest to declare. Dr D’Angelillo Rolando Maria has no conflict of interest to declare.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Ramella, S., Mandoliti, G., Trodella, L. et al. The first survey on defensive medicine in radiation oncology. Radiol med 120, 421–429 (2015). https://doi.org/10.1007/s11547-014-0465-1
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s11547-014-0465-1