			Home About us Contact

Defensive Medicine (defensive + medicine)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

A Longitudinal Study of Emergency Medicine Residents' Malpractice Fear and Defensive Medicine

ACADEMIC EMERGENCY MEDICINE, Issue 6 2007
Robert M. Rodriguez MD
Objectives:To determine the baseline level and evolution of defensive medicine and malpractice concern (MC) of emergency medicine (EM) residents. Methods:Using a validated instrument consisting of case scenarios and Likert-type scale questions, the authors performed a prospective, longitudinal (June 2001 to June 2005) study of EM residents at five 4-year California residency programs. Results:All 51 EM interns of these residencies were evaluated; four residents left their programs and one took medical leave, resulting in 46 graduating residents evaluated. MC did not affect the residency choice of interns. Although perceived likelihood of serious disease increased in case scenarios over time, defensive medicine decreased in 27% of cases and increased in 20%. On a scale with 1 representing extremely influential and 5 representing not at all influential, the mean (±SD) influence of MC on interns' and graduates' case evaluation and management was 2.5 (±1.1) and 2.7 (±1.0), respectively. Comparing interns and graduates, there was no significant difference in the percentages of respondents who declared MC (mean difference in proportions, 3.3%; 95% CI =,8.4% to 15%) or refused procedures because of MC (11.5%; 95% CI =,1.3% to 24.3%). More interns, however, declared substantial loss of enjoyment of medicine than graduates (48%; 95% CI = 30.3% to 65.5%). Conclusions:Physicians enter four-year EM residencies in California with moderate MC and defensive medicine, which do not change significantly over time and do not markedly impact their decisions to perform emergency department procedures. Malpractice fear markedly decreases interns' enjoyment of medicine, but this effect decreases by residency completion. [source]

Trust, Staking, and Expectations

JOURNAL FOR THE THEORY OF SOCIAL BEHAVIOUR, Issue 3 2009
PHILIP J. NICKEL
Trust is a kind of risky reliance on another person. Social scientists have offered two basic accounts of trust: predictive expectation accounts and staking (betting) accounts. Predictive expectation accounts identify trust with a judgment that performance is likely. Staking accounts identify trust with a judgment that reliance on the person's performance is worthwhile. I argue (1) that these two views of trust are different, (2) that the staking account is preferable to the predictive expectation account on grounds of intuitive adequacy and coherence with plausible explanations of action; and (3) that there are counterexamples to both accounts. I then set forward an additional necessary condition on trust (added to the staking view), according to which trust implies a moral expectation. When A trusts B to do x, A ascribes to B an obligation to do x, and holds B to this obligation. This Moral Expectation view throws new light on some of the consequences of misplaced trust. I use the example of physicians' defensive behavior/defensive medicine to illustrate this final point. [source]

CRIMINALIZATION OF MEDICAL ERROR: WHO DRAWS THE LINE?

ANZ JOURNAL OF SURGERY, Issue 10 2007
Sidney W. A. Dekker
As stakeholders struggle to reconcile calls for accountability and pressures for increased patient safety, criminal prosecution of surgeons and other health-care workers for medical error seems to be on the rise. This paper examines whether legal systems can meaningfully draw a line between acceptable performance and negligence. By questioning essentialist assumptions behind ,crime' or ,negligence', this paper suggests that multiple overlapping and partially contradictory descriptions of the same act are always possible, and even necessary, to approximate the complexity of reality. Although none of these descriptions is inherently right or wrong, each description of the act (as negligence, or system failure, or pedagogical issue) has a fixed repertoire of responses and countermeasures appended to it, which enables certain courses of action while excluding others. Simply holding practitioners accountable (e.g. by putting them on trial) excludes any beneficial effects as it produces defensive posturing, obfuscation and excessive stress and leads to defensive medicine, silent reporting systems and interference with professional oversight. Calls for accountability are important, but accountability should be seen as bringing information about needed improvements to levels or groups that can do something about it, rather than deflecting resources into legal protection and limiting liability. We must avoid a future in which we have to turn increasingly to legal systems to wring accountability out of practitioners because legal systems themselves have increasingly created a climate in which telling each other accounts openly is less and less possible. [source]