title: Medical liability, defensive medicine and professional insurance in otolaryngology.
abstract: BACKGROUND
  This study aims at verifying relationships between the perception of medico-legal risks involved in the professional activity of Italian otolaryngologists, defensive medical behaviour and their understanding of professional liability insurance in matters of civil liability. One hundred specialists replied to a questionnaire pertaining to the psychological impact of medico-legal issues and to specific queries regarding insurance coverage, either privately stipulated or provided by the employer. Statistic analysis was carried out by χ(2) test and ANOVA multiple variance regression test, assuming P = 0.05 as the value of minimum statistical significance.
  
  
  RESULTS
  It was found that in 50% of cases the behaviour of the doctor towards the patient had been decidedly influenced by concerns over medico-legal implications. In 29% of the sample these concerns had "often to always" influenced the choice of diagnostic procedures or treatment options, in order to safeguard themselves in case of legal dispute. The data obtained showed a statistically significant correlation between the level of concern (regarding potential medico-legal disputes) experienced by specialists on the one hand and variations in the doctor/patient relationship (P < 0.05) and the choice of defensive medical procedures (P < 0.05) on the other. Furthermore, the perception of the medico-legal problem was statistically related to the absence or poor knowledge of some insurance clauses, regarding posthumous coverage (72%), informed written consent (89%), and the coverage provided by the healthcare centre where the specialist is employed (32%) (P < 0.05).
  
  
  CONCLUSIONS
  The results of this study indicate the necessity for a greater awareness of the actual guarantees provided by the insurance policy stipulated by specialists, to avoid inadequate coverage in the case of medico-legal disputes.
authors.affiliation: Department of Neurosciences, Institute of Otorhinolaryngology, Ateneo "Federico II", Via S. Pansini no. 5, 80100, Naples, Italy. sermotta@yahoo.it.|, Via Stazio no 8, 80123, Naples, Italy. sermotta@yahoo.it.
authors.forename: Sergio
authors.initials: S
authors.lastname: Motta
authors.affiliation: Department of Otorhinolaryngology, II University of Naples, Via S. Pansini no 5, 80100, Naples, Italy. domenictesta@libero.it.
authors.forename: Domenico
authors.initials: D
authors.lastname: Testa
authors.affiliation: Department of Neurosciences, Institute of Otorhinolaryngology, Ateneo "Federico II", Via S. Pansini no. 5, 80100, Naples, Italy. ugo.cesari@unina.it.
authors.forename: Ugo
authors.initials: U
authors.lastname: Cesari
authors.affiliation: Department of Forensic Medicine, University "Federico II", Via S. Pansini no 5, 80100, Naples, Italy. quaremba@unina.it.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Quaremba
authors.affiliation: Department of Otorhinolaryngology, II University of Naples, Via S. Pansini no 5, 80100, Naples, Italy. gae.motta@libero.it.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Motta
mesh_terms: D000328:Adult; D003675:Defensive Medicine / Q000331:legislation & jurisprudence*; D005260:Female; D006801:Humans; D007351:Insurance, Liability; D007558:Italy; D016365:Liability, Legal; D008297:Male; D008875:Middle Aged; D010036:Otolaryngology / Q000379:methods* / Q000458:organization & administration*; D010465:Perception; D010817:Physician-Patient Relations; D010820:Physicians; D012044:Regression Analysis; D011795:Surveys and Questionnaires