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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 [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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Metadata
- 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
- 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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