title: Malpractice liability and defensive medicine: a national survey of neurosurgeons.
abstract: BACKGROUND
  Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons' perceptions of malpractice liability and defensive medicine practices.
  
  
  METHODS
  A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices.
  
  
  RESULTS
  A total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a "major or extreme" burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns.
  
  
  CONCLUSIONS
  Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.
authors: Department of Neurosurgery, Massachusetts General Hospital, Boston, Massachusets, United States of America. bnahed@partners.org
authors: Brian V
authors: BV
authors: Nahed
authors: Maya A
authors: MA
authors: Babu
authors: Timothy R
authors: TR
authors: Smith
authors: Robert F
authors: RF
authors: Heary
mesh_terms: D001291:Attitude of Health Personnel; D003675:Defensive Medicine / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007351:Insurance, Liability; D008297:Male; D008318:Malpractice / Q000191:economics / Q000331:legislation & jurisprudence*; D009493:Neurosurgery / Q000191:economics / Q000706:statistics & numerical data / Q000639:trends*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D011795:Surveys and Questionnaires