Legal concerns trigger prostate-specific antigen testing.
BACKGROUND
In the United States, lawsuits against physicians have had an impact on their behaviour, resulting in overdiagnosis and other forms of 'defensive medicine'. Does a similar situation exist in Switzerland? Using prostate-specific antigen (PSA) screening as an example, we surveyed Swiss physicians and assessed the extent to which liability fears influenced their recommendation for testing.


METHODS
At a continuing medical education conference we distributed a pilot-tested questionnaire to 552 participants. Two hundred and fifty of them (45%) completed the questionnaire.


RESULTS
Of the participants, 158 (68%) were general practitioners and 73 (32%) specialists in internal medicine. Seventy-five per cent of both groups recommend regular PSA screening to men older than age 50. Yet only 56% of the general physicians and 53% of the internists believe that PSA measurement is an effective screening method. A substantial proportion of the physicians - 41% of general practitioners and 43% of internists - reported that they sometimes or often recommend this test for legal reasons.


CONCLUSIONS
Defensive medicine is not a phenomenon particular to the USA, but is also observable in Switzerland. This result is surprising, given that in Switzerland and other European countries, a physician who does not recommend a test or treatment whose effectiveness is controversial need not fear litigation.
Steurer
Johan
J
Horten Centre for Patient Orientated Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland. johann.steurer@usz.ch
Held
Ulrike
U
Schmidt
Mathias
M
Gigerenzer
Gerd
G
Tag
Brigitte
B
Bachmann
Lucas M
LM