title: How concerns and experiences with medical malpractice affect dermatopathologists' perceptions of their diagnostic practices when interpreting cutaneous melanocytic lesions.
abstract: OBJECTIVE
  We sought to identify characteristics associated with past malpractice lawsuits and how malpractice concerns may affect interpretive practices.
  
  
  METHODS
  We surveyed 207 of 301 (68.8%) eligible dermatopathologists who interpret melanocytic skin lesions in 10 states. The survey assessed dermatopathologists' demographic and clinical practice characteristics, perceptions of how medical malpractice concerns could influence their interpretive practices, and past malpractice lawsuits.
  
  
  RESULTS
  Of dermatopathologists, 33% reported past malpractice experiences. Factors associated with being sued included older age (57 vs 48 years, P < .001), lack of board certification or fellowship training in dermatopathology (76.5% vs 53.2%, P = .001), and greater number of years interpreting melanocytic lesions (>20 years: 52.9% vs 20.1%, P < .001). Of participants, 64% reported being moderately or extremely confident in their melanocytic interpretations. Although most dermatopathologists believed that malpractice concerns increased their likelihood of ordering specialized pathology tests, obtaining recuts, and seeking a second opinion, none of these practices were associated with past malpractice. Most dermatopathologists reported concerns about potential harms to patients that may result from their assessments of melanocytic lesions.
  
  
  CONCLUSIONS
  Limitations of this study include lack of validation of and details about the malpractice suits experienced by participating dermatopathologists. In addition, the study assessed perceptions of practice rather than actual practices that might be associated with malpractice incidents.
  
  
  CONCLUSIONS
  Most dermatopathologists reported apprehension about how malpractice affects their clinical practice and are concerned about patient safety irrespective of whether they had actually experienced a medical malpractice suit.
authors.affiliation: Department of Family Medicine, Oregon Health and Science University, Portland, Oregon; Department of Public Health and Preventive Medicine, Oregon Health and Science University, Portland, Oregon. Electronic address: carneyp@ohsu.edu.
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.affiliation: Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Frederick
authors.affiliation: Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Reisch
authors.affiliation: Pathology Associates, Clovis, California.
authors.forename: Stevan
authors.initials: S
authors.lastname: Knezevich
authors.affiliation: Department of Medicine, University of Washington School of Medicine, Seattle, Washington; Dermatopathology Northwest, Bellevue, Washington.
authors.forename: Michael W
authors.initials: MW
authors.lastname: Piepkorn
authors.affiliation: Department of Pathology, University of California, Los Angeles, California; Department of Pathology, Institut Curie, Paris, France.
authors.forename: Raymond L
authors.initials: RL
authors.lastname: Barnhill
authors.affiliation: Pathology, University of Pennsylvania, Philadelphia, Pennsylvania.
authors.forename: David E
authors.initials: DE
authors.lastname: Elder
authors.affiliation: Family Medicine, University of Vermont, Burlington, Vermont.
authors.forename: Berta M
authors.initials: BM
authors.lastname: Geller
authors.affiliation: Epidemiology and of Pediatrics, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire.
authors.forename: Linda
authors.initials: L
authors.lastname: Titus
authors.affiliation: Dermatology and Epidemiology, Center for Dermatoepidemiology, Department of Veterans Affairs Medical Center, Providence, Rhode Island; Department of Dermatology, Rhode Island Hospital, Providence, Rhode Island; Departments of Dermatology and Epidemiology, Brown University, Providence, Rhode Island.
authors.forename: Martin A
authors.initials: MA
authors.lastname: Weinstock
authors.affiliation: Department of Medical Informatics and Clinical Epidemiology, Oregon Health and Science University, Portland, Oregon; Department of Medicine, Oregon Health and Science University, Portland, Oregon; Cancer Prevention and Screening, Providence Cancer Center, Providence Health and Services Oregon, Portland, Oregon.
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Nelson
authors.affiliation: Department of Internal Medicine, University of Washington School of Medicine, Seattle, Washington.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D002568:Certification / Q000331:legislation & jurisprudence*; D002983:Clinical Competence; D003880:Dermatology / Q000331:legislation & jurisprudence*; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D005260:Female; D006801:Humans; D008297:Male; D008318:Malpractice / Q000331:legislation & jurisprudence*; D008545:Melanoma / Q000175:diagnosis*; D008875:Middle Aged; D010336:Pathology / Q000331:legislation & jurisprudence*; D061214:Patient Safety; D010465:Perception; D010820:Physicians / Q000331:legislation & jurisprudence / Q000523:psychology*; D010818:Practice Patterns, Physicians'; D012017:Referral and Consultation; D020377:Self Efficacy; D012878:Skin Neoplasms / Q000175:diagnosis*
keywords: additional histology testing; clinical interpretation; defensive clinical practice; dermatopathology; medical malpractice; melanoma