Defensive neurosurgery up in states with high liability risk

(HealthDay)—Neurosurgeons are more likely to practice defensive medicine in states with high state-level liability risk, according to a study published in the February issue of Neurosurgery.

Timothy R. Smith, M.D., Ph.D., M.P.H., from Northwestern University in Chicago, and colleagues examined the correlation of defensive medicine with the liability environment. Data were collected from 1,026 neurosurgeons' responses to a 51-question online survey. The survey, which had previously been validated, included questions related to neurosurgeon, practice, and patient characteristics; perceptions of the liability environment; and defensive medicine behaviors.

The researchers found that 83 percent of respondents correctly identified that they were practicing in a high-risk environment, indicating that neurosurgeons' perceptions of their state's liability environment generally corresponded to objective measures of state-level liability risk. Neurosurgeons were 50 percent more likely to practice defensive medicine in high-risk states versus low-risk states, after adjustment for surgeon experience, income, high-risk patient load, liability history, and type of patient insurance.

"Both avoidance and assurance behaviors are prevalent among U.S. neurosurgeons and are correlated with subjective and objective measures of state-level liability risk," the authors write. "Defensive medicine practices do not align with patient-centered care and may contribute to increased inefficiency in an already taxed health care system."

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