Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons
Open accessAbstract
BACKGROUND: Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons' perceptions of malpractice liability and defensive medicine practices. METHODS: A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices. RESULTS: A total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a "major or extreme" burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. CONCLUSIONS: Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.
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Clinicians' decision making can be greatly impacted by the potential medical liability risk, which often leads to selecting defensive practices, such as ordering unnecessary tests and referrals, that are perceived as mitigating malpractice claim risk instead of clinically necessary actions to avoid legal issues.
“Clinicians’ decision making can be greatly impacted by the potential medical liability risk, which often leads to selecting defensive practices, such as ordering unnecessary tests and referrals, that are perceived as mitigating malpractice claim risk instead of clinically necessary actions to avoid legal issues [262,263,264].”
From Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors (2026) · cites this paper as [263]
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Cites
The Social Transformation of American Medicine
Leavitt, J. W., & Starr, P. (1984) · The American Historical Review · doi:10.2307/1862729 · Cited by 3,257 · see citing works
Defensive Medicine Among High-Risk Specialist Physicians in a Volatile Malpractice Environment
Studdert, D. M. (2005) · JAMA · doi:10.1001/jama.293.21.2609 · Cited by 1,270 · see citing works
Malpractice Risk According to Physician Specialty
Jena, A. B., Seabury, S., Lakdawalla, D., & Chandra, A. (2011) · New England Journal of Medicine · doi:10.1056/nejmsa1012370 · Cited by 1,180 · see citing works
The Social Transformation of American Medicine
Kissick, W. L., & Starr, P. (1983) · Journal of Policy Analysis and Management · doi:10.2307/3324029 · Cited by 735 · see citing works
The Social Transformation of American Medicine
Starr, P. (1982) · DigitalGeorgetown (Georgetown University Library) · Cited by 519 · see citing works
National Costs Of The Medical Liability System
Mello, M. M., Chandra, A., Gawande, A. A., & Studdert, D. M. (2010) · Health Affairs · doi:10.1377/hlthaff.2009.0807 · Cited by 498 · cited 1× · see citing works
“Regardless of actual outcomes, the threat of litigation influences how neurosurgeons utilize defensive medicine practices [18].”
BackgroundOveruse of Health Care Services in the United States
Korenstein, D. R. (2012) · Archives of Internal Medicine · doi:10.1001/archinternmed.2011.772 · Cited by 236 · see citing works
American Medical Malpractice Litigation in Historical Perspective
Mohr, J. C. (2000) · JAMA · doi:10.1001/jama.283.13.1731 · Cited by 226 · see citing works
Brown, T. W., McCarthy, M. L., Kelen, G. D., & Levy, F. (2010) · Academic Emergency Medicine · doi:10.1111/j.1553-2712.2010.00729.x · Cited by 213 · see citing works
Effect of Fear of Litigation on Obstetric Care: A Nationwide Analysis on Obstetric Practice
Zwecker, P., Azoulay, L., & Abenhaim, H. A. (2011) · American Journal of Perinatology · doi:10.1055/s-0030-1271213 · Cited by 138 · see citing works
Patient Education on Prostate Cancer Screening and Involvement in Decision Making
Krist, A. H., Woolf, S. H., Johnson, R. E., & Kerns, J. W. (2007) · The Annals of Family Medicine · doi:10.1370/afm.623 · Cited by 127 · see citing works
Effects of a Malpractice Crisis on Specialist Supply and Patient Access to Care
Mello, M. M., Studdert, D. M., DesRoches, C. M., Peugh, J., Zapert, K., Brennan, T. A., & Sage, W. M. (2005) · Annals of Surgery · doi:10.1097/01.sla.0000182957.54783.9a · Cited by 86 · see citing works
Doctors and the Law: Medical Jurisprudence in Nineteenth-Century America
Grob, G. N., & Mohr, J. C. (1995) · The Journal of Interdisciplinary History · doi:10.2307/205838 · Cited by 57 · see citing works
Medical Malpractice in Nineteenth-Century America: Origins and Legacy
Papke, D. R., & Ville, K. A. D. (1991) · Journal of the Early Republic · doi:10.2307/3123516 · Cited by 54 · see citing works
The Relationship Between Geographic Variations and Overuse of Healthcare Services
Keyhani, S., Falk, R., Bishop, T. F., Howell, E. A., & Korenstein, D. R. (2012) · Medical Care · doi:10.1097/mlr.0b013e3182422b0f · Cited by 49 · see citing works
Garg, P. P., Landrum, M. B., Normand, S. T., Ayanian, J. Z., Hauptman, P. J., Ryan, T. J., McNeil, B. J., & Guadagnoli, E. (2002) · Medical Care · doi:10.1097/00005650-200207000-00008 · Cited by 49 · see citing works
Helmchen, L. A., Richards, M. R., & McDonald, T. B. (2010) · Medical Care · doi:10.1097/mlr.0b013e3181eaf84d · Cited by 39 · see citing works
THE HISTORY OF PROFESSIONAL LIABILITY SUITS IN THE UNITED STATES
Sandor, A. A. (1957) · JAMA · doi:10.1001/jama.1957.82970410010018 · Cited by 37 · see citing works
How much does defensive medicine cost?
Rubin, R. J., & Mendelson, D. N. (1994) · PubMed · Cited by 35 · see citing works
Malpractice Risk and Cost Are Significantly Reduced after Tort Reform
Stewart, R. M., Geoghegan, K., Myers, J. G., Sirinek, K. R., Corneille, M. G., Mueller, D. L., Dent, D. L., Wolf, S. E., & Pruitt, B. A. (2011) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2010.12.025 · Cited by 29 · see citing works
Doctors and the Law: Medical Jurisprudence in Nineteenth- Century America
Mohr, J. C. (1993) · Cited by 5 · see citing works
Doctors and the Law: Medical Jurisprudence in Nineteenth-Century America
Hatton, E., & Mohr, J. C. (1994) · American Journal of Legal History · doi:10.2307/845395 · Cited by 4 · see citing works
Medical Malpractice in Nineteenth-Century America: Origins and Legacy
De Ville, K. A. (1990) · Cited by 3 · see citing works
Leukopenia; its classification, etiology and treatment.
Mohr, J. C. (1946) · PubMed · Cited by 3 · see citing works
LEGAL RESPONSIBILITY FOR MEDICAL MALPRACTICE
SMITH, H. W. (1941) · JAMA · doi:10.1001/jama.1941.72820270004008 · Cited by 2 · see citing works
Tort reform: alternative models.
Scarrow, A. M. (2008) · PubMed · Cited by 2 · see citing works
Analysis of California's Medical Injury Compensation Review Act (MICRA).
Evans, M. B. (2004) · PubMed · Cited by 1 · see citing works
&NA; (1913) · The Journal of Nervous and Mental Disease · doi:10.1097/00005053-191305000-00025 · Cited by 1 · see citing works
Culbertson, H. E. (n.d.) · Cited by 1 · see citing works
Flagged first, then by citations
Research works printed but not linked: 2
- [6]Mohr JC 1992 The origins of medical malpractice in the United States. Trans Stud Coll Physicians Phila 14 1 21 1604464
- [16]Krist AH Woolf SH Johnson RE 2007 How physicians approach prostate cancer screening before and after losing a lawsuit. Ann Fam Med 5 120 5 17389535 PMC1838685
Cited by
Sorted by citations
A systematic survey of computer-aided diagnosis in medicine: Past and present developments
Yanase, J., & Triantaphyllou, E. (2019) · Expert Systems with Applications · doi:10.1016/j.eswa.2019.112821 · Cited by 303 · see citing works
Improving Medical Student Recruitment into Neurological Surgery: A Single Institution's Experience
Agarwal, N., Norrmén-Smith, I. O., Tomei, K. L., Prestigiacomo, C. J., & Gandhi, C. D. (2013) · World Neurosurgery · doi:10.1016/j.wneu.2013.08.027 · Cited by 102 · see citing works
Malpractice litigation following spine surgery
Daniels, A. H., Ruttiman, R. J., Eltorai, A. E. M., DePasse, J. M., Brea, B. A., & Palumbo, M. A. (2017) · Journal of Neurosurgery Spine · doi:10.3171/2016.11.spine16646 · Cited by 84 · see citing works
Medical Malpractice in Neurosurgery: A Comprehensive Analysis
Thomas, R., Gupta, R., Griessenauer, C. J., Moore, J. M., Adeeb, N., Motiei-Langroudi, R., Guidal, B., Agarwal, N., Alterman, R. L., Friedlander, R. M., et al. (2017) · World Neurosurgery · doi:10.1016/j.wneu.2017.11.051 · Cited by 74 · see citing works
Prevalence and costs of defensive medicine: a national survey of Italian physicians
Panella, M., Rinaldi, C., Leigheb, F., Knesse, S., Donnarumma, C., Kul, S., Vanhaecht, K., & Stanislao, F. D. (2017) · Journal of Health Services Research & Policy · doi:10.1177/1355819617707224 · Cited by 74 · see citing works
How defensive medicine is defined in European medical literature: a systematic review
Baungaard, N., Skovvang, P. L., Hvidt, E. A., Gerbild, H. N., Andersen, M. K. K., & Lykkegaard, J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-057169 · Cited by 70 · see citing works
Descriptive Analysis of State and Federal Spine Surgery Malpractice Litigation in the United States
Agarwal, N., Gupta, R., Agarwal, P., Matthew, P., Wolferz, R., Shah, A., Adeeb, N., Prabhu, A. V., Kanter, A. S., Okonkwo, D. O., et al. (2017) · Spine · doi:10.1097/brs.0000000000002510 · Cited by 65 · see citing works
Ries, N. M., & Jansen, J. (2021) · Health Policy · doi:10.1016/j.healthpol.2021.02.005 · Cited by 63 · see citing works
The determinants of defensive medicine in Italian hospitals: The impact of being a second victim
Panella, M., Rinaldi, C., Leigheb, F., Donnarumma, C., Kul, S., Vanhaecht, K., & Stanislao, F. D. (2016) · Revista de Calidad Asistencial · doi:10.1016/j.cali.2016.04.010 · Cited by 63 · see citing works
Classification of Histopathology Images of Lung Cancer Using Convolutional Neural Network (CNN)
Baranwal, N., Doravari, P., & Kachhoria, R. (2022) · CRC Press eBooks · doi:10.1201/9781003272694-7 · Cited by 63 · see citing works
Legal Liability in Iatrogenic Orbital Injury
Svider, P. F., Kovalerchik, O., Mauro, A. C., Baredes, S., & Eloy, J. A. (2013) · The Laryngoscope · doi:10.1002/lary.24000 · Cited by 61 · see citing works
Defensive Medicine in Neurosurgery
Smith, T. R., Habib, A., Rosenow, J. M., Nahed, B. V., Babu, M. A., Cybulski, G. R., Fessler, R. D., Batjer, H. H., & Heary, R. F. (2014) · Neurosurgery · doi:10.1227/neu.0000000000000576 · Cited by 59 · see citing works
Self-citationSvider, P. F., Blake, D. M., Husain, Q. M., Mauro, A. C., Turbin, R. E., Eloy, J. A., & Langer, P. D. (2014) · Ophthalmic Plastic and Reconstructive Surgery · doi:10.1097/iop.0000000000000025 · Cited by 58 · see citing works
Blake, D. M., Svider, P. F., Carniol, E. T., Mauro, A. C., Eloy, J. A., & Jyung, R. W. (2013) · Otolaryngology · doi:10.1177/0194599813498696 · Cited by 54 · see citing works
A nine-year review of medicolegal claims in neurosurgery
Mukherjee, S., Pringle, C., & Crocker, M. (2014) · Annals of The Royal College of Surgeons of England · doi:10.1308/003588414x13814021679834 · Cited by 51 · see citing works
Review of Neurosurgery Medical Professional Liability Claims in the United States
Elsamadicy, A. A., Sergesketter, A. R., Frakes, M., & Lad, S. P. (2018) · Neurosurgery · doi:10.1093/neuros/nyx565 · Cited by 47 · see citing works
Zhu, L., Li, L., & Lang, J. (2018) · BMJ Open · doi:10.1136/bmjopen-2017-019752 · Cited by 47 · see citing works
Kakemam, E., Arab‐Zozani, M., Raeissi, P., & Albelbeisi, A. H. (2022) · BMC Health Services Research · doi:10.1186/s12913-022-08194-w · Cited by 48 · see citing works
Zhang, J. K., del Valle, A. J., Alexopoulos, G., Patel, N., van Nispen, J., Patel, M. S., Xu, E., Mercier, P., Kohn, N. A., & Mattei, T. A. (2022) · The Spine Journal · doi:10.1016/j.spinee.2022.03.015 · Cited by 41 · see citing works
Chen, J., Majercik, S. D., Bledsoe, J. R., Connor, K., Morris, B., Gardner, S., Scully, C., Wilson, E. L., Dickerson, J., White, T., et al. (2015) · The American Journal of Surgery · doi:10.1016/j.amjsurg.2015.03.016 · Cited by 41 · see citing works
Yan, S. C., Hulou, M. M., Coté, D. J., Roytowski, D., Rutka, J. T., Gormley, W. B., & Smith, T. R. (2016) · World Neurosurgery · doi:10.1016/j.wneu.2016.07.069 · Cited by 41 · see citing works
Self-citationFargen, K. M., & Friedman, W. A. (2014) · World Neurosurgery · doi:10.1016/j.wneu.2014.03.030 · Cited by 41 · see citing works
Value-based neurosurgery: measuring and reducing the cost of microvascular decompression surgery
McLaughlin, N., Upadhyaya, P., Buxey, F., & Martin, N. A. (2014) · Journal of neurosurgery · doi:10.3171/2014.5.jns131996 · Cited by 41 · see citing works
Health Transformation Project and Defensive Medicine Practice among Neurosurgeons in Turkey
Solaroğlu, İ., İzci, Y., Yeter, H. G., Metin, M. M., & Keles, G. E. (2014) · PLoS ONE · doi:10.1371/journal.pone.0111446 · Cited by 40 · see citing works
Defensive medicine among neurosurgeons in the Netherlands: a national survey
Yan, S. C., Hulsbergen, A. F. C., Muskens, I. S., van Dam, M., Gormley, W. B., Broekman, M. L. D., & Smith, T. R. (2017) · Acta Neurochirurgica · doi:10.1007/s00701-017-3323-9 · Cited by 39 · see citing works
Self-citationLi, S., & Brantley, E. (2015) · Journal of the American College of Radiology · doi:10.1016/j.jacr.2015.09.015 · Cited by 41 · see citing works
Probst, M. A., Kanzaria, H. K., & Schriger, D. L. (2014) · The American Journal of Emergency Medicine · doi:10.1016/j.ajem.2014.01.003 · Cited by 36 · see citing works
Malpractice Litigation in Plastic Surgery: Can We Identify Patterns?
Sarmiento, S., Wen, C., Cheah, M. A., Lee, S., & Rosson, G. D. (2019) · Aesthetic Surgery Journal · doi:10.1093/asj/sjz258 · Cited by 36 · see citing works
HANRAHAN, J. G., Sideris, M. C., Tsitsopoulos, P. P., Bimpis, A., Pasha, T., Whitfield, P. C., & Papalois, A. E. (2018) · Annals of Medicine and Surgery · doi:10.1016/j.amsu.2018.08.002 · Cited by 35 · see citing works
The first survey on defensive medicine in radiation oncology
Ramella, S., Mandoliti, G., Trodella, L., & D’Angelillo, R. M. (2014) · La radiologia medica · doi:10.1007/s11547-014-0465-1 · Cited by 33 · see citing works
Defensive Medicine in U.S. Spine Neurosurgery
Din, R. S., Yan, S. C., Coté, D. J., Acosta, M. A., & Smith, T. R. (2016) · Spine · doi:10.1097/brs.0000000000001687 · Cited by 32 · see citing works
Self-citationNeurosurgical Ethics in Practice: Value-based Medicine
Ammar, A., & Bernstein, M. (2014) · Springer eBooks · doi:10.1007/978-3-642-54980-9 · Cited by 31 · see citing works
Panje, C. M., Glatzer, M., Sirén, C. A., Plaßwilm, L., & Putora, P. M. (2018) · JCO Clinical Cancer Informatics · doi:10.1200/cci.18.00017 · Cited by 29 · see citing works
Kessler, R. A., Benzil, D. L., Loewenstern, J., Chen, S. L., Bhammar, A., Kohli, K. M., Hadjipanayis, C. G., Scarrow, A. M., Bederson, J. B., & Shrivastava, R. K. (2018) · World Neurosurgery · doi:10.1016/j.wneu.2018.11.112 · Cited by 29 · see citing works
Sankey, E. W., Mehta, V. A., Wang, T. Y., Than, T. T., Goodwin, C. R., Karikari, I. O., Shaffrey, C. I., Abd‐El‐Barr, M. M., & Than, K. D. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.8.focus20600 · Cited by 28 · see citing works
The determinants of defensive medicine practices in Belgium
Vandersteegen, T., Marneffe, W., Cleemput, I., Vandijck, D. M., & Vereeck, L. (2016) · Health Economics Policy and Law · doi:10.1017/s174413311600030x · Cited by 27 · see citing works
Arafa, A., Negida, A., Elsheikh, M., Emadeldin, M., Hegazi, H., & Senosy, S. A. (2023) · Scientific Reports · doi:10.1038/s41598-023-47720-6 · Cited by 26 · see citing works
Steele, L., Mukherjee, S., Stratton‐Powell, A. A., Anderson, I., & Timothy, J. (2015) · British Journal of Neurosurgery · doi:10.3109/02688697.2015.1054362 · Cited by 25 · see citing works
Guillain, A., Moncany, A.-H., Hamel, O., Gerson, C., Bougeard, R., Dran, G., & Debono, B. (2020) · Acta Neurochirurgica · doi:10.1007/s00701-020-04302-z · Cited by 24 · see citing works
Osti, M., & Steyrer, J. M. (2015) · Journal of Evaluation in Clinical Practice · doi:10.1111/jep.12305 · Cited by 23 · see citing works
Renkema, E., Ahaus, K., Broekhuis, M., & Tims, M. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-025108 · Cited by 23 · see citing works
Lasers and Losers in the Eyes of the Law
Svider, P. F., Carron, M. A., Zuliani, G. F., Eloy, J. A., Setzen, M., & Folbe, A. J. (2014) · JAMA Facial Plastic Surgery · doi:10.1001/jamafacial.2014.21 · Cited by 22 · see citing works
Safaee, M., Morshed, R. A., Spatz, J., Sankaran, S., Berger, M. S., & Aghi, M. K. (2018) · Journal of neurosurgery · doi:10.3171/2018.3.jns173224 · Cited by 22 · see citing works
Malpractice claims in spine surgery in Germany: a 5-year analysis
Ahmadi, S. A., Sadat, H., Scheufler, K.-M., Steiger, H., Weber, B., & Beez, T. (2019) · The Spine Journal · doi:10.1016/j.spinee.2019.02.001 · Cited by 22 · see citing works
Breast cancer malpractice litigation: A 10-year analysis and update in trends
Lee, M. V., Konstantinoff, K., Gegios, A. R., Miles, K. M., Appleton, C. M., & Hui, D. S. (2019) · Clinical Imaging · doi:10.1016/j.clinimag.2019.12.001 · Cited by 22 · see citing works
The Personal and Professional Impact of Patients’ Complaints on Doctors—A Qualitative Approach
Hanganu, B., & Ioan, B. G. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph19010562 · Cited by 21 · see citing works
Protecting the most vulnerable: Litigation from pediatric otolaryngologic procedures and conditions
Rose, C., Svider, P. F., Sheyn, A. M., Meadows, L., Eloy, J. A., Coticchia, J. M., & Folbe, A. J. (2014) · The Laryngoscope · doi:10.1002/lary.24663 · Cited by 21 · see citing works
Triberti, S., Durosini, I., Curigliano, G., & Pravettoni, G. (2020) · Public Health Genomics · doi:10.1159/000506014 · Cited by 21 · see citing works
Medical Malpractice Claims and Mitigation Strategies Following Spine Surgery
Jackson, K. L., Rumley, J. C., Griffith, M. S., Linkous, T. R., Agochukwu, U. F., & DeVine, J. G. (2020) · Global Spine Journal · doi:10.1177/2192568220939524 · Cited by 21 · see citing works
Hawasli, A. H., Chicoine, M. R., & Dacey, R. G. (2014) · Neurosurgery · doi:10.1227/neu.0000000000000560 · Cited by 20 · see citing works
Impact of Medical Malpractice Environment on Surgical Quality and Outcomes
Minami, C. A., Chung, J. W., Holl, J. L., & Bilimoria, K. Y. (2013) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2013.09.007 · Cited by 20 · see citing works
Neurosurgical Defensive Medicine in Texas and Illinois: A Tale of 2 States
Coté, D. J., Karhade, A. V., Giantini-Larsen, A., Castlen, J. P., & Smith, T. R. (2016) · World Neurosurgery · doi:10.1016/j.wneu.2016.01.080 · Cited by 20 · see citing works
Self-citationExperiences of neurological surgeons with malpractice lawsuits
Gadjradj, P. S., Ghobrial, J. B., & Harhangi, B. S. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.8.focus20250 · Cited by 18 · see citing works
Bilimoria, K. Y., Sohn, M., Chung, J. W., Minami, C. A., Oh, E. H., Pavey, E. S., Ho, K. J., Black, B. S., Mello, M. M., & Bentrem, D. J. (2016) · Annals of Surgery · doi:10.1097/sla.0000000000001538 · Cited by 17 · see citing works
Spine surgery and malpractice liability in the United States
Missios, S., & Bekelis, K. (2015) · The Spine Journal · doi:10.1016/j.spinee.2015.03.041 · Cited by 17 · see citing works
Svider, P. F., Pashkova, A. A., Vidal, G.-P., Mauro, A. C., Eloy, J. A., & Chokshi, R. J. (2013) · Journal of Gastrointestinal Surgery · doi:10.1007/s11605-013-2261-y · Cited by 16 · see citing works
McLaughlin, N., Garrett, M. C., Emami, L., Foss, S. K., Klohn, J. L., & Martin, N. A. (2015) · Journal of neurosurgery · doi:10.3171/2014.11.jns132653 · Cited by 16 · see citing works
Delayed diagnosis in primary care-The main cause of sarcoma litigation in the United Kingdom
Harrison, W. D., Sargazi, N., Yin, Q., & Chandrasekar, C. R. (2016) · Journal of Surgical Oncology · doi:10.1002/jso.24149 · Cited by 16 · see citing works
Unattractive Consequences: Litigation From Facial Dermabrasion and Chemical Peels
Svider, P. F., Jiron, J., Zuliani, G. F., Shkoukani, M. A., Folbe, A. J., & Carron, M. A. (2014) · Aesthetic Surgery Journal · doi:10.1177/1090820x14547948 · Cited by 15 · see citing works
Debono, B., Hamel, O., Guillain, A., Durand, A., Rué, M., Sabatier, P., Lonjon, G., & Dran, G. (2020) · Neurochirurgie · doi:10.1016/j.neuchi.2020.05.003 · Cited by 15 · see citing works
Malodorous consequences: What comprises negligence in anosmia litigation?
Svider, P. F., Mauro, A. C., Eloy, J. A., Setzen, M., Carron, M. A., & Folbe, A. J. (2014) · International Forum of Allergy & Rhinology · doi:10.1002/alr.21257 · Cited by 15 · see citing works
Perceptions of Indian neurosurgeons about medicolegal issues and malpractice suits
Garg, K., Sharma, R., Raheja, A., Tandon, V., Katiyar, V., Dash, C., Bhatnagar, R., Khullar, M. K., Raju, B., Nanda, A., et al. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.8.focus20592 · Cited by 15 · see citing works
Dambrino, R. J., Zuckerman, S. L., Guidry, B. S., Domenico, H. J., Thompson, R. C., Galloway, M. B., Pichert, J. W., & Cooper, W. O. (2020) · Journal of neurosurgery · doi:10.3171/2020.4.jns20870 · Cited by 14 · see citing works
Defensive Medicine Practices: Scale Development and Validation
Ünal, Ö., & Akbolat, M. (2021) · Medical Decision Making · doi:10.1177/0272989x211043077 · Cited by 14 · see citing works
Malpractice litigation after spinal surgery: A review of allegations in France in 1990–2020
Rougereau, G., Marty‐Diloy, T., Bonaccorsi, R., Vialle, R., Boisrenoult, P., Pascal‐Moussellard, H., & Langlais, T. (2022) · Orthopaedics & Traumatology Surgery & Research · doi:10.1016/j.otsr.2022.103510 · Cited by 14 · see citing works
Physician, know thyself: implicit and explicit decision-making for mechanical thrombectomy in stroke
Fargen, K. M., Leslie‐Mazwi, T. M., Chen, M., & Hirsch, J. A. (2020) · Journal of NeuroInterventional Surgery · doi:10.1136/neurintsurg-2020-015973 · Cited by 14 · see citing works
Epistaxis: the factors involved in determining medicolegal liability
Khan, M. N., Blake, D. M., Vazquez, A., Setzen, M., Baredes, S., & Eloy, J. A. (2013) · International Forum of Allergy & Rhinology · doi:10.1002/alr.21229 · Cited by 13 · see citing works
The Practice of Cranial Neurosurgery and the Malpractice Liability Environment in the United States
Bekelis, K., Missios, S., Wong, K. K., & MacKenzie, T. A. (2015) · PLoS ONE · doi:10.1371/journal.pone.0121191 · Cited by 13 · see citing works
Helmchen, L. A., Lambert, B. L., & McDonald, T. B. (2016) · Health Services Research · doi:10.1111/1475-6773.12610 · Cited by 13 · see citing works
Teles, A. R., Cabrera, J., Riew, K. D., & Falavigna, A. (2015) · World Neurosurgery · doi:10.1016/j.wneu.2015.12.045 · Cited by 13 · see citing works
Geographic Variation in Costs of Transsphenoidal Pituitary Surgery in the United States
Asemota, A. O., Ishii, M., Brem, H., & Gallia, G. L. (2020) · World Neurosurgery · doi:10.1016/j.wneu.2020.02.145 · Cited by 12 · see citing works
Better care is the best defense: High-value clinical practice vs defensive medicine
Sulmasy, L. S., & Weinberger, S. E. (2014) · Cleveland Clinic Journal of Medicine · doi:10.3949/ccjm.81a.14037 · Cited by 12 · see citing works
Medical Malpractice and Diagnostic Radiology: Challenges and Opportunities
Sumner, C., Kietzman, A. T., Kadom, N., Frigini, L. A., Makary, M. S., Martin, A., McKnight, C. D., Retrouvey, M., Spieler, B. M., & Griffith, B. D. (2023) · Academic Radiology · doi:10.1016/j.acra.2023.08.015 · Cited by 13 · see citing works
Malpractice liability and defensive medicine in anesthesia: Egyptian anesthesiologists’ perspectives
Shehata, S. A., Kamhawy, G. A., Farghaly, R. M., Mostafa, E. M. A., Galal, R. F., & Ismail, R. A. (2022) · Egyptian Journal of Anaesthesia · doi:10.1080/11101849.2022.2118976 · Cited by 11 · see citing works
A comparison of malpractice lawsuits mediated and judged in court in China
Li, Y., Gao, D. W., Liang, W., Qiu, L., Liu, X., Zhang, L., & Deng, Z.-H. (2018) · Journal of Forensic and Legal Medicine · doi:10.1016/j.jflm.2018.01.002 · Cited by 11 · see citing works
Impressions of defensive medical practice and medical litigation among South African neurosurgeons
Roytowski, D., Smith, T. R., Fieggen, G. A. G., & Taylor, A. (2014) · South African Medical Journal · doi:10.7196/samj.8336 · Cited by 11 · see citing works
Self-citationThe Ethics of “Choosing Wisely”: The Use of Neuroimaging for Uncomplicated Headache
Coté, D. J., & Laws, E. R. (2017) · Neurosurgery · doi:10.1093/neuros/nyw180 · Cited by 11 · see citing works
Neurosurgical Recruitment: The Gold Rush
Tomasello, F. F. (2013) · World Neurosurgery · doi:10.1016/j.wneu.2013.11.004 · Cited by 10 · see citing works
Tang, O. Y., Hartnett, D. A., Hays, S. B., Syed, S. H., & Daniels, A. H. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.8.focus20601 · Cited by 9 · see citing works
Correlation Between Malpractice Litigation and Legislation Reform in Taiwan Over a 30-Year Period
Hsieh, M.-T., Lu, L.-H., Lin, C.-W., & Chen, Y. (2021) · International Journal of General Medicine · doi:10.2147/ijgm.s312640 · Cited by 9 · see citing works
Tanrıverdi, Ö., Şenler, F. Ç., Yavuzşen, T., Turhal, S., Akman, T., Kömürcü, Ş., Çehreli, R., & Özyılkan, Ö. (2015) · Medical Oncology · doi:10.1007/s12032-015-0555-5 · Cited by 9 · see citing works
Cho, S.-H., Lee, J.-Y., Ryu, K.-H., & Suh, D. C. (2018) · Neurointervention · doi:10.5469/neuroint.2018.13.1.48 · Cited by 8 · see citing works
Fears and fallacies: Doctors’ perceptions of the barriers to medical innovation
Elliott, T., Miola, J., Samanta, A., & Samanta, J. (2019) · Clinical Ethics · doi:10.1177/1477750919886090 · Cited by 7 · see citing works
Delıce, O., Tekin, E., & Yılmaz, S. (2019) · Eurasian Journal of Emergency Medicine · doi:10.4274/eajem.galenos.2019.49404 · Cited by 7 · see citing works
Medical Malpractice and Vestibular Schwannomas: A Nationwide Review
Bader, E. R., Boyke, A. E., Alvi, M. A., Sethi, A., Funari, A., & Agarwal, V. J. (2021) · World Neurosurgery · doi:10.1016/j.wneu.2021.03.093 · Cited by 7 · see citing works
Pediatric neurosurgery malpractice claims in Germany
Beez, T., Steiger, H., Weber, B., & Ahmadi, S. A. (2018) · Child s Nervous System · doi:10.1007/s00381-018-3963-y · Cited by 7 · see citing works
Chan, A. K.-H., Santacatterina, M., Pennicooke, B. H., Shahrestani, S., Ballatori, A. M., Orrico, K. O., Burke, J. F., Manley, G. T., Tarapore, P. E., Huang, M. C., et al. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.8.focus20610 · Cited by 7 · see citing works
Leadership and Advanced Degrees
Pyfer, B. J., Hernandez, J. A., Glener, A. D., Cason, R. W., Levinson, H., & Phillips, B. T. (2021) · Annals of Plastic Surgery · doi:10.1097/sap.0000000000003029 · Cited by 7 · see citing works
Menger, R., Wolf, M. E., Lang, R. W., Smith, D. R., Nanda, A., Letarte, P. B., & Rosner, M. K. (2015) · Neurosurgery · doi:10.1227/neu.0000000000001084 · Cited by 7 · see citing works
Defensive Medicine: A Tax/Surcharge for the Delivery of Healthcare
Fronczak, S. (2016) · World Neurosurgery · doi:10.1016/j.wneu.2016.08.068 · Cited by 7 · see citing works
Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors
Yen, C., Epling, J. W., Rockwell, M., & Vaughn-Cooke, M. (2026) · Diagnostics · doi:10.3390/diagnostics16020347 · Cited by 6 · see citing works
Guerrini, F., Bertolino, L., Safa, A., Pittarello, M., Parisi, A. M., Beretta, L. V., Zambelli, E., Totis, F., Campanaro, G., Pavia, L., et al. (2024) · Brain Sciences · doi:10.3390/brainsci14070627 · Cited by 6 · see citing works
Dijkstra, R. J. (2015) · European Journal of Law and Economics · doi:10.1007/s10657-015-9484-1 · Cited by 6 · see citing works
Tewarie, I. A., Hulsbergen, A. F. C., Volovici, V., & Broekman, M. L. D. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.8.focus20597 · Cited by 6 · see citing works
Disciplinary law and neurosurgery: a 10-year analysis of cases in the Netherlands
Dronkers, W. J., Amelink, Q. J. M. A., Buis, D. R., Broekman, M. L. D., & Spoor, J. K. H. (2020) · Neurosurgical FOCUS · doi:10.3171/2020.8.focus20561 · Cited by 6 · see citing works
LaLonde, L., Good, J., Orkopoulou, E., Vriesman, M., & Maragakis, A. (2022) · Journal of Contextual Behavioral Science · doi:10.1016/j.jcbs.2022.01.001 · Cited by 6 · see citing works
Chen, B., Chapman, C. G., Floyd, S. B., Mobley, J. F., & Brooks, J. M. (2021) · BMC Health Services Research · doi:10.1186/s12913-021-06544-8 · Cited by 6 · see citing works
How to Improve the Attractiveness of Neurosurgery
Quintana, L. M. (2015) · World Neurosurgery · doi:10.1016/j.wneu.2015.09.010 · Cited by 6 · see citing works
Defensive Medicine in Neurosurgery: The Sub-Saharan Africa Experience
Waterkeyn, F., Ikwuegbuenyi, C. A., Balogun, S. A., Thys, M., Sabas, R. R., Lekuya, H. M., & Vanpee, D. (2025) · Neurosurgery · doi:10.1227/neu.0000000000003620 · Cited by 5 · see citing works
Patient negligence in healthcare systems: Accountability model formulation
Moukalled, T., & Elhaj, A. (2021) · Health Policy OPEN · doi:10.1016/j.hpopen.2021.100037 · Cited by 5 · see citing works
- Authors
- Nahed, B. V., Babu, M. A., Smith, T. R., & Heary, R. F.
- Affiliations
- Massachusetts General Hospital (US)
- Mayo Clinic (US)
- Northwestern University (US)
- University of Medicine and Dentistry of New Jersey (US)
- Corresponding author
- Nahed, Brian V.
- Babu, Maya A.
- Venue
- PLoS ONE
- Publisher
- Public Library of Science (PLoS)
- Published
- 2012-06-22
- Volume
- 7
- Issue
- 6
- Pages
- e39237
- ISSN
- 1932-6203 (ISSN-L)
- PMC
- PMC3382203
- OpenAlex
- W1965052854
- Cited by
- 197
- References
- 29
- Citations by year
- 2026: 8 · 2025: 8 · 2024: 24 · 2023: 14 · 2022: 18 · 2021: 17 · 2020: 22 · 2019: 12 · 2018: 12 · 2017: 8 · 2016: 10 · 2015: 17 · 2014: 18 · 2013: 8 · 2012: 1
- FWCI
- 32.92
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Locations
- PLoS ONE (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Digital Access to Scholarship at Harvard (DASH) (Harvard University) (submittedVersion, cc-by)
- RePEc: Research Papers in Economics (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Funders
- Congress of Neurological Surgeons
- Topics
- Health Sciences › Health Professions › Pharmacy › Medical Malpractice and Liability Issues
- Health Sciences › Health Professions › General Health Professions › Healthcare cost, quality, practices
- Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
- Keywords
- defensive medicine, medical malpractice liability, neurosurgeons, malpractice premiums, diagnostic testing, image studies, high-risk procedures, health care costs, medical-legal risk, patient access to care
- MeSH terms
- Attitude of Health Personnel, Defensive Medicine, Female, Humans, Insurance, Liability, Male, Malpractice, Neurosurgery, Practice Patterns, Physicians', Surveys and Questionnaires, Health Care Surveys
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