Defensive medicine in neurosurgery: does state-level liability risk matter?

Area of Science:

• Neurosurgery
• Medical Malpractice Law
• Healthcare Policy

Background:

• Defensive medicine is common among US neurosurgeons due to malpractice claim risks.
• This study quantifies defensive behaviors and perceptions nationally.

Purpose of the Study:

• To investigate the link between defensive medicine (assurance and avoidance behaviors) and the legal liability environment.
• To determine if state-level liability risk influences neurosurgeons' practice patterns.

Main Methods:

• An anonymous online survey was distributed to 3344 US neurosurgeons.
• The survey assessed neurosurgeon, patient, and practice characteristics, liability perceptions, and defensive medicine behaviors.
• Bivariate and multivariate analyses correlated state liability risk with defensive practice likelihood.

Main Results:

• 1026 neurosurgeons responded (31% rate).
• 83% accurately perceived their state's liability risk level.
• Neurosurgeons in high-risk states were 50% more likely to practice defensively (OR 1.5, P<.05), even after controlling for other factors.

Conclusions:

• Defensive medicine behaviors (avoidance and assurance) are prevalent and linked to liability risk.
• Defensive practices are misaligned with patient-centered care.
• These practices may increase healthcare system inefficiency.