在高风险的专科医生中,在一个不稳定的不良医疗环境中,防御医学是高风险的
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
概括
医生经常练习防御医学,订购不必要的测试,并避免某些患者,因为不当的担忧. 这会影响医疗保健的成本和质量.
科学领域:
- 医疗法律和伦理学
- 医疗服务研究 医疗服务研究
- 临床实践管理的管理.
背景情况:
- 防御性医学的实践,医生改变临床行为由于不当行为责任的威胁,是医疗不当行为改革辩论中的一个关键问题.
- 了解防御医学的流行和后果对于政策讨论至关重要.
研究的目的:
- 调查高责任专业的医生中防御医学的频率和特征.
- 检查在严重的不当行为环境不稳定时期的防御性医学实践.
主要方法:
- 2003年5月,在宾夕法尼亚州的六个高风险专业的医生中进行了一项邮件调查:急诊医学,整体外科,骨科手术,神经外科,妇产科和放射学.
- 收集的数据包括报告防御医学或实践变化的范围的医生人数,以及采用的防御医学类型 (保证和避免行为).
主要成果:
- 在824名接受调查的医生中,93%表示从事防御医学.
- 保证行为,比如订购额外的测试 (92%),是常见的,其中43%使用临床上不必要的成像. 避免行为,如限制实践或避免高风险患者,也很普遍 (42%的实践受到限制).
- 防御性做法与对责任保险的低信心和高感知保险费负担有很强的相关性.
结论:
- 防御医学在宾夕法尼亚州的医生中非常普遍,他们面临着高昂的责任保险费用.
- 这种做法对医疗保健成本,患者获得护理以及医疗服务的技术和人际关系质量产生了重大潜在的负面影响.
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