Malpractice and Patient Safety Concerns.

Area of Science:

• Pathology
• Medical Practice
• Healthcare Policy

Background:

• "Assurance behaviors" are defensive medicine practices where physicians order extra services to mitigate legal risks.
• These behaviors, including additional tests and consultations, aim to prevent adverse legal outcomes.

Purpose of the Study:

• To compare the frequency of clinical behaviors driven by malpractice concerns versus patient safety concerns among dermatopathologists.
• To investigate the motivations behind ordering additional tests, services, and consultations in dermatopathology.

Main Methods:

• A national online survey was administered to 160 dermatopathologists.
• Participants reported on the use of five specific clinical behaviors motivated by malpractice and patient safety concerns.

Main Results:

• Nearly all participants (95% for malpractice, 99% for patient safety) reported using clinical behaviors for these reasons.
• Higher proportions of dermatopathologists cited patient safety concerns for ordering additional immunohistochemistry/molecular tests (90% vs 71%), recommending additional surgical sampling (91% vs 78%), requesting additional slides (95% vs 81%), and obtaining second reviews (91% vs 78%).
• No significant difference was found in adding caveats to reports (89% vs 85%).

Conclusions:

• Dermatopathologists frequently employ clinical behaviors for both assurance and patient safety.
• Patient safety concerns were reported as a more common motivation than malpractice concerns for several specific clinical actions.