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.
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.
- 1. Nash L, Tennant C, Walton M. The psychological impact of complaints and negligence suits on doctors. Australas Psychiatry 2004; 12: 278-281.
- 2. Jain A, Ogden J. General practitioners’ experience of patients’ complaints: a qualitative study. BMJ 1999; 318: 1596-1599.
- 3. Mello MM, Studdert DM, Desroches CM, et al. Caring for patients in a malpractice crisis: physician satisfaction and quality of care. Health Aff 2004; 23: 42-53.
- 4. Cook R, Neff C. Attitudes of physicians in northern Ontario to medical malpractice litigation. Can Fam Physician 1994; 40: 689-698.
- 5. Summerton N. Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ 1995; 310: 27-29.
- 6. Nash L, Curtis B, Walton M, et al. The response of doctors to a formal complaint. Australas Psychiatry 2006; 14: 246-250.
- 7. Studdert DM, Mello MM, Sage W, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 2005; 293: 2609-2617.
- 8. Common good fear of litigation study. The impact on medicine. Final report, 2002. http://commongood.org/assets/attachments/57.pdf (accessed Oct 2010).
- 9. Charles SC, Wilbert JR, Kennedy EC. Physician’s self-reports to reactions to malpractice litigation. Am J Psychiatry 1984; 141: 563-565.
- 10. Weisman C, Morlock L, Teitelbaum M, et al. Practice changes in response to the malpractice litigation climate. Results of a Maryland physician survey. Med Care 1989; 27: 16-24.
- 11. Elmore J, Taplin S, Barlow W, et al. Does litigation influence medical practice? The influence of community radiologists’ medical malpractice perceptions and experience on screening mammography. Radiology 2005; 236: 37-46.
- 12. Birbeck G, Gifford D, Song J, et al. Do malpractice concerns, payment mechanisms, and attitudes influence test-ordering decisions? Neurology 2004; 62: 119-121.
- 13. Hiyama T, Yoshihara M, Tanaka S, et al. Defensive medicine practices among gastroenterologists in Japan. World J Gastroenterol 2006; 12: 7671-7675.
- 14. Cunningham W. The immediate and long-term impact on New Zealand doctors who receive patient complaints. N Z Med J 2004; 117: 972.
- 15. Cunningham W, Dovey S. Defensive changes in medical practice and the complaints process: a qualitative study of New Zealand doctors. N Z Med J 2006; 119: 1244.
- 16. Nash L, Walton M, Daly M, et al. GPsí concerns about medicolegal issues ó how it affects their practice. Aust Fam Physician 2009; 38: 66-70.
- 17. Nash LM, Kelly PJ, Daly MG, et al. Australian doctors’ involvement in medicolegal matters: a cross-sectional self-report study. Med J Aust 2009; 191: 436-440. <MJA full text>
- 18. NSW Therapeutic Advisory Group Inc. Guidelines. http://www.ciap.health.nsw.gov.au/nswtag/guidelines.html (accessed Oct 2010).
- 19. Rogers v Whitaker (1992) 175 CLR 479.
- 20. Wilson RMcL, Runciman WB, Gibberd RW, et al. The Quality in Australian Health Care Study. Med J Aust 1995; 163: 458-471. <MJA full text>
- 21. Brennan TA, Leape LL, Laird N, et al. Incidence of adverse events and negligence in hospitalized patients. Results of the Harvard Medical Practice study I. N Engl J Med 1991; 324: 370-376.
- 22. Baker GR, Norton PG, Flintoft V, et al. The Canadian Adverse Events Study: the incidence of adverse events among hospital patients in Canada. CMAJ 2004; 170: 1678-1686.
- 23. Runciman WB, Merry A, Walton M. Safety and ethics in health care: a guide to getting it right. 1st ed. London: Ashgate Publishers, 2007.
- 24. Henry DA, Kerridge IH, Hill SR, et al. Medical specialists and pharmaceutical industry-sponsored research: a survey of the Australian experience. Med J Aust 2005; 182: 557-560. <MJA full text>
- 25. Australian Institute of Health and Welfare. Medical labour force 2005. National health labour force series no. 40. Canberra: AIHW, 2008. (AIHW cat. no. HWL 41.) http://www.aihw.gov.au/publications/index.cfm/title/10548 (accessed Oct 2010).
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