International Defensive Medicine in Neurosurgery: A Comparison of Canada, South Africa, and the United States.

International Defensive Medicine in Neurosurgery: A Comparison of Canada, South Africa, and the United States.

World Neurosurg. 2016 Jul 28;

Authors: Yan SC, Hulou MM, Cote DJ, Roytowski D, Rutka JT, Gormley WB, Smith TR

Abstract
OBJECTIVE: Perception of medico-legal risk has been shown to influence defensive medicine behaviors. Canada, South Africa, and the U.S. have three vastly different healthcare and medico-legal systems. There has been no previous study comparing defensive medicine practices internationally.
METHODS: An online survey was sent to 3,672 neurosurgeons across Canada, South Africa, and the U.S. The survey included questions on the following domains: surgeon demographics, patient characteristics, physician practice type, surgeon liability profile, defensive behavior - including questions on the frequency of ordering additional imaging, laboratory tests, and consults - and perception of the liability environment. Responses were analyzed, and multivariate logistic regression was used to examine the correlation of medico-legal risk environment and defensive behavior.
RESULTS: The response rate was 30.3% in the U.S. (n=1,014), 36.5% in Canada (n=62), and 41.8% in South Africa (n=66). Canadian neurosurgeons reported an average annual malpractice premium of $19,110 (SD=$11,516), compared to $16,262 (SD=$7,078) for South African respondents, $75,857 (SD=$50,775) for neurosurgeons from low-risk U.S. states, and $128,181 (SD=$79,355) for those from high-risk U.S. states. Neurosurgeons from South Africa were 2.8 times more likely to engage in defensive behaviors compared to Canadian neurosurgeons, while neurosurgeons from low-risk U.S. states were 2.6 times more likely. Neurosurgeons from high-risk U.S. states were 4.5 times more likely to practice defensively compared to Canadian neurosurgeons.
CONCLUSIONS: Neurosurgeons from the U.S. and South Africa are more likely to practice defensively than neurosurgeons from Canada. Perception of medico-legal risk is correlated with reported neurosurgical defensive medicine within these countries.

PMID: 27476695 [PubMed - as supplied by publisher]

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