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Malpractice Fears, Patient Safety Drive Skin Doctors to Order Extra Tests

In a survey, dermatopathologists cite patient safety, malpractice fears as reason to use extra patient services

TUESDAY, Aug. 4, 2020 (HealthDay News) — The practice of requesting additional, sometimes unnecessary tests or obtaining second opinions by dermatopathologists is often driven both by patient safety and malpractice concerns, according to a study published online July 17 in the American Journal of Clinical Pathology.

Lisa M. Reisch, Ph.D., of the University of Washington in Seattle, and colleagues conducted an online survey with 160 dermatopathologists in 33 states to discover how malpractice concerns compare with patient safety concerns in driving “defensive medicine” behaviors. Participants were asked about their motivation when ordering extra tests, recommending additional surgical sampling, requesting other slides, obtaining second opinions, and adding caveats into reports regarding lesion difficulty.

The researchers found that patient safety and malpractice concerns prompted participants to utilize additional clinical behaviors. Still, a higher proportion of participants cited patient safety concerns as a motivator. Ninety-five percent of participants reported using one or more of five clinical practices due to malpractice concerns, while 99 percent reported using one or more of these clinical behaviors due to patient safety concerns. Ninety percent of the dermatopathologists surveyed cited patient safety, and 71 percent cited malpractice fears as key motivators when ordering additional immunohistochemistry/molecular tests. When requesting a second opinion or recommending additional surgical sampling, 91 percent cited patient safety and 78 percent cited malpractice concerns. Eighty-five percent of respondents cited malpractice concerns and 89 percent cited patient safety when adding caveats into reports regarding lesion difficulty.

“Dermatopathologists are influenced to request additional tests, services, and consultations because of concerns about patient safety (to do no harm) and also because of concerns about medical malpractice,” the authors write. “Our findings call into question the perception that, beyond attempts to diagnose and manage patients accurately, physicians order additional services exclusively due to fears of malpractice.”

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