How concerns and experiences with medical malpractice affect dermatopathologists' perceptions of their diagnostic practices when interpreting cutaneous melanocytic lesions

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• 作者：Patricia A. Carney ; PhD^a ; ^b ; ^{carneyp@ohsu.edu" class="auth_mail" title="E-mail the corresponding author} ; Paul D. Frederick ; MPH ; MBA^e ; Lisa M. Reisch ; PhD^e ; Stevan Knezevich ; MD ; PhD^g ; Michael W. Piepkorn ; MD^f ; ^h ; Raymond L. Barnhill ; MDⁱ ; ^j ; David E. Elder ; MB Chb ; FRCPA^k ; Berta M. Geller ; EdD^l ; Linda Titus ; PhD^m ; Martin A. Weinstock ; MD ; PhDⁿ ; ^o ; ^p ; Heidi D. Nelson ; MD ; MPH^c ; ^d ; ^q ; Joann G. Elmore ; MD ; MPH^e
• 关键词：additional histology testing ; clinical interpretation ; defensive clinical practice ; dermatopathology ; medical malpractice ; melanoma
• 刊名：Journal of the American Academy of Dermatology
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：74
• 期：2
• 页码：317-324.e8
• 全文大小：4131 K

文摘

We sought to identify characteristics associated with past malpractice lawsuits and how malpractice concerns may affect interpretive practices.

Methods

We surveyed 207 of 301 (68.8%) eligible dermatopathologists who interpret melanocytic skin lesions in 10 states. The survey assessed dermatopathologists' demographic and clinical practice characteristics, perceptions of how medical malpractice concerns could influence their interpretive practices, and past malpractice lawsuits.

Results

Of dermatopathologists, 33% reported past malpractice experiences. Factors associated with being sued included older age (57 vs 48 years, P < .001), lack of board certification or fellowship training in dermatopathology (76.5% vs 53.2%, P = .001), and greater number of years interpreting melanocytic lesions (>20 years: 52.9% vs 20.1%, P < .001). Of participants, 64% reported being moderately or extremely confident in their melanocytic interpretations. Although most dermatopathologists believed that malpractice concerns increased their likelihood of ordering specialized pathology tests, obtaining recuts, and seeking a second opinion, none of these practices were associated with past malpractice. Most dermatopathologists reported concerns about potential harms to patients that may result from their assessments of melanocytic lesions.

Limitations

Limitations of this study include lack of validation of and details about the malpractice suits experienced by participating dermatopathologists. In addition, the study assessed perceptions of practice rather than actual practices that might be associated with malpractice incidents.

Conclusions

Most dermatopathologists reported apprehension about how malpractice affects their clinical practice and are concerned about patient safety irrespective of whether they had actually experienced a medical malpractice suit.