Cited by 197Medical Malpractice and Liability IssuesHealthcare cost, quality, practicesHealthcare Policy and Management

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Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons

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Nahed, Brian V., Babu, Maya A., Smith, Timothy R., Heary, Robert F.·2012·PLoS ONE

DOI 10.1371/journal.pone.0039237PMC PMC3382203

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Abstract

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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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.
ORCID: Nahed, Brian V.
Babu, Maya A.
Smith, Timothy R.
Heary, Robert F.
Venue: PLoS ONE
Publisher: Public Library of Science (PLoS)
Published: 2012-06-22
Volume: 7
Issue: 6
Pages: e39237
ISSN: 1932-6203 (ISSN-L)
DOI: 10.1371/journal.pone.0039237
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
Licence: cc-by
creativecommons.org/licenses/by/4.0/ (unspecified)
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: Social Sciences › Law › 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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Malpractice Liability and Defensive Medicine: A National Survey of Neurosurgeons

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