Physician surveys to assess customary care in medical malpractice cases.
OBJECTIVE
Physician experts hired and prepared by the litigants provide most information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, we examined the feasibility and potential value of surveying community physicians to assess standard of care.


METHODS
Seven physician surveys of mutually exclusive groups of randomly selected physicians.


METHODS
Iowa.


METHODS
Community and academic primary care physicians and relevant specialists.


METHODS
Included in each survey was a case vignette of a primary care malpractice case and key quotes from medical experts on each side of the case. Surveyed physicians were asked whether the patient should have been referred to a specialist for additional evaluation. The 7 case vignettes included 3 closed medical malpractice cases, 3 modifications of these cases, and 1 active case.


RESULTS
Sixty-three percent of 350 community primary care physicians and 51% of 216 community specialists completed the questionnaire. For 3 closed cases, 47%, 78%, and 88% of primary care physician respondents reported that they would have made a different referral decision than the defendant. Referral percentages were minimally affected by modifying patient outcome but substantially changed by modifying patient presentation. Most physicians, even those whose referral decisions were unusual, assumed that other physicians would make similar referral decisions. For each case, at least 65% of the primary care physicians disagreed with the testimony of one of the expert witnesses. In the active case, the response rate was high (71%), and the respondents did not withhold criticism of the defendant doctor.


CONCLUSIONS
Randomly selected peer physicians are willing to participate in surveys of medical malpractice cases. The surveys can be used to construct the distribution of physician self-reported practice relevant to a particular malpractice case. This distribution may provide more information about customary practice or standard of care than the opinion of a single physician expert.
College of Medicine, Department of Family Medicine, University of Iowa, Iowa City, Iowa 52242-1097, USA. authur-hartz@uiowa.edu
Arthur
A
Hartz
Joshua
J
Lucas
Timothy
T
Cramm
Michael
M
Green
Suzanne
S
Bentler
John
J
Ely
Steven
S
Wolfe
Paul
P
James
D005104:Expert Testimony; D005240:Feasibility Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007484:Iowa; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D011320:Primary Health Care / Q000331:legislation & jurisprudence* / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D015203:Reproducibility of Results