高リスクの専門医の間の防衛医学は,不安定な誤診の環境における不安定な誤診の環境にある
David M Studdert1, Michelle M Mello, William M Sage
1Department of Health Policy and Management, Harvard School of Public Health, Boston, Mass 02115, USA. studdert@hsph.harvard.edu
JAMA
|June 2, 2005
まとめ
医者はしばしば防御医学を実践し,不必要な検査を命じ,誤診の懸念のために特定の患者を避けます. これは医療費と医療の質に影響を及ぼします.
科学分野:
- 医療法と医療倫理について
- 医療サービス 研究 医療サービス
- クリニック・プラクティス・マネジメント
背景:
- 医者が誤診の責任の脅威のために臨床行動を変更する防御的医療の実践は,医療誤診改革の議論の重要な問題です.
- 防衛医療の流行と結果を理解することは,政策議論にとって極めて重要です.
研究 の 目的:
- 高責任の専門分野における医師の間で防御医学の頻度と特徴を調査する.
- 重要な誤診の時期,環境の不安定な時期における防御的医療の実践を検証する.
主な方法:
- 2003年5月,ペンシルベニア州の6つの高リスク専門分野の医師を対象に郵送調査が行われました:緊急医療,一般外科,整形外科,神経外科,産婦人科,放射線外科です.
- 収集されたデータには,防御医学または実践の変化の範囲を報告した医師の数,および使用された防御医学の種類 (保証と回避行動) が含まれていました.
主要な成果:
- 調査対象の824人の医師の93%が,防御医学を実践していると報告しています.
- 余分な検査 (92%) を注文するなど,アシュアランスな行動が一般的であり,43%が臨床的に不要な画像を用いた. 実践を制限したり,高リスクの患者を避けるなどの回避行動も一般的であった (42%は実践を制限した).
- 防御的な慣行は,責任保険に対する信頼の低下と,高い保険料負担と強く相関していた.
結論:
- ペンシルベニア州では,高額な責任保険費用に直面している医師の間で,防衛医学が非常に一般的です.
- この慣行は,医療費,患者の医療へのアクセス,医療サービスの技術的および人際的品質に重大な潜在的悪影響を及ぼします.
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