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Perceived practice change in Australian doctors as a result of medicolegal concerns

Louise M Nash, Merrilyn M Walton, Michele G Daly, Patrick J Kelly, Garry Walter, Elizabeth H van Ekert, Simon M Willcock and Christopher C Tennant
Med J Aust 2010; 193 (10): 579-583.

Summary

Objectives: To explore the perceived impact of medicolegal concerns on how Australian doctors practise medicine and to compare doctors who have experienced a medicolegal matter with those who have not.

Design and setting: Cross-sectional survey (posted in September 2007, with reminder 4 weeks later) of Australian doctors from all major specialty groups, trainees and a sample of general practitioners who were insured with a medical insurance company.

Participants: 2999 respondents of 8360 who were sent the survey.

Main outcome measures: Perceived practice changes due to concerns about medicolegal issues, beliefs about medicolegal issues, and the influence of medicolegal issues on both career choices and how doctors relate to their patients.

Results: Respondents reported changes in practice behaviour due to medicolegal concerns, with 43% of doctors stating that they referred patients more than usual, 55% stating that they ordered tests more than usual, and 11% stating that they prescribed medications more than usual. Respondents also reported improved communication of risk (66%), increased disclosure of uncertainty (44%), developed better systems for tracking results (48%) and better methods for identifying non-attenders (39%) and for auditing clinical practice (35%). Concerns about medicolegal issues led to 33% considering giving up medicine, 32% considering reducing their working hours and 40% considering retiring early. These proportions were all significantly greater for doctors who had previously experienced a medicolegal matter compared with those who had not.

Conclusions: This Australian study, like international studies, confirms that doctors’ concerns about medicolegal issues impact on their practice in a variety of ways. There is a greater perceived impact on those doctors who have previously experienced a medicolegal matter.

  • Louise M Nash0,2
  • Merrilyn M Walton3
  • Michele G Daly4
  • Patrick J Kelly3
  • Garry Walter2,5
  • Elizabeth H van Ekert6
  • Simon M Willcock7
  • Christopher C Tennant7

  • 1 New South Wales Institute of Psychiatry, Sydney, NSW.
  • 2 Discipline of Psychological Medicine, University of Sydney, Sydney, NSW.
  • 3 Sydney School of Public Health, University of Sydney, Sydney, NSW.
  • 4 Academic GP Unit, Hornsby Ku-ring-gai Hospital, University of Sydney, Sydney, NSW.
  • 5 Northern Sydney Central Coast Health Service, Sydney, NSW.
  • 6 MDA National, Sydney, NSW.
  • 7 University of Sydney, Sydney, NSW.


Acknowledgements: 

Funding for this study was received from Northern Sydney Health, the University of Sydney and Avant.

Competing interests:

None identified.

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