title: Defensive medicine in neurosurgery: the Canadian experience.
abstract: OBJECT Recent studies have examined the impact of perceived medicolegal risk and compared how this perception impacts defensive practices within the US. To date, there have been no published data on the practice of defensive medicine among neurosurgeons in Canada. METHODS An online survey containing 44 questions was sent to 170 Canadian neurosurgeons and used to measure Canadian neurosurgeons' perception of liability risk and their practice of defensive medicine. The survey included questions on the following domains: surgeon demographics, patient characteristics, type of physician practice, surgeon liability profile, policy coverage, defensive behaviors, and perception of the liability environment. Survey responses were analyzed and summarized using counts and percentages. RESULTS A total of 75 neurosurgeons completed the survey, achieving an overall response rate of 44.1%. Over one-third (36.5%) of Canadian neurosurgeons paid less than $5000 for insurance annually. The majority (87%) of Canadian neurosurgeons felt confident with their insurance coverage, and 60% reported that they rarely felt the need to practice defensive medicine. The majority of the respondents reported that the perceived medicolegal risk environment has no bearing on their preferred practice location. Only 1 in 5 respondent Canadian neurosurgeons (21.8%) reported viewing patients as a potential lawsuit. Only 4.9% of respondents would have selected a different career based on current medicolegal risk factors, and only 4.1% view the cost of annual malpractice insurance as a major burden. CONCLUSIONS Canadian neurosurgeons perceive their medicolegal risk environment as more favorable and their patients as less likely to sue than their counterparts in the US do. Overall, Canadian neurosurgeons engage in fewer defensive medical behaviors than previously reported in the US.
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School;
authors.forename: Timothy R
authors.initials: TR
authors.lastname: Smith
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School;
authors.forename: M Maher
authors.initials: MM
authors.lastname: Hulou
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School;
authors.forename: Sandra C
authors.initials: SC
authors.lastname: Yan
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School;
authors.forename: David J
authors.initials: DJ
authors.lastname: Cote
authors.affiliation: Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts;
authors.forename: Brian V
authors.initials: BV
authors.lastname: Nahed
authors.affiliation: Department of Neurological Surgery, Mayo Medical School, Rochester, Minnesota;
authors.forename: Maya A
authors.initials: MA
authors.lastname: Babu
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada; and.
authors.forename: Sunit
authors.initials: S
authors.lastname: Das
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School;
authors.forename: William B
authors.initials: WB
authors.lastname: Gormley
authors.affiliation: Division of Neurosurgery, Department of Surgery, University of Toronto, Ontario, Canada; and.
authors.forename: James T
authors.initials: JT
authors.lastname: Rutka
authors.affiliation: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School;
authors.forename: Edward R
authors.initials: ER
authors.lastname: Laws
authors.affiliation: Department of Neurological Surgery, Rutgers New Jersey Medical School, Newark, New Jersey.
authors.forename: Robert F
authors.initials: RF
authors.lastname: Heary
mesh_terms: D000328:Adult; D000368:Aged; D001291:Attitude of Health Personnel; D002170:Canada; D003431:Cross-Cultural Comparison; D003675:Defensive Medicine; D005260:Female; D006801:Humans; D008297:Male; D008318:Malpractice; D008875:Middle Aged; D009493:Neurosurgery; D012306:Risk; D011795:Surveys and Questionnaires
keywords: CMPA = Canadian Medical Protective Association; Canada; DM = defensive medicine; defensive medicine; liability; malpractice; neurosurgery