title: Legal concerns trigger prostate-specific antigen testing.
abstract: 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.
authors.affiliation: Horten Centre for Patient Orientated Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland. johann.steurer@usz.ch
authors.forename: Johan
authors.initials: J
authors.lastname: Steurer
authors.forename: Ulrike
authors.initials: U
authors.lastname: Held
authors.forename: Mathias
authors.initials: M
authors.lastname: Schmidt
authors.forename: Gerd
authors.initials: G
authors.lastname: Gigerenzer
authors.forename: Brigitte
authors.initials: B
authors.lastname: Tag
authors.forename: Lucas M
authors.initials: LM
authors.lastname: Bachmann