title: Medical malpractice concerns and defensive medicine: a nationwide survey of breast pathologists.
abstract: OBJECTIVE
  "Assurance behaviors" in medical practice involve providing additional services of marginal or no medical value to avoid adverse outcomes, deter patients from filing malpractice claims, or ensure that legal standards of care were met. The extent to which concerns about medical malpractice influence assurance behaviors of pathologists interpreting breast specimens is unknown.
  
  
  METHODS
  Breast pathologists (n = 252) enrolled in a nationwide study completed an online survey of attitudes regarding malpractice and perceived alterations in interpretive behavior due to concerns of malpractice. Associations between pathologist characteristics and the impact of malpractice concerns on personal and colleagues' assurance behaviors were determined by χ(2) and logistic regression analysis.
  
  
  RESULTS
  Most participants reported using one or more assurance behaviors due to concerns about medical malpractice for both their personal (88%) and colleagues' (88%) practices, including ordering additional stains, recommending additional surgical sampling, obtaining second reviews, or choosing the more severe diagnosis for borderline cases. Nervousness over breast pathology was positively associated with assurance behavior and remained statistically significant in a multivariable logistic regression model (odds ratio, 2.5; 95% confidence interval, 1.0-6.1; P = .043).
  
  
  CONCLUSIONS
  Practicing US breast pathologists report exercising defensive medicine by using assurance behaviors due to malpractice concerns.
authors.affiliation: From the Department of Medicine, University of Washington School of Medicine, Seattle;
authors.forename: Lisa M
authors.initials: LM
authors.lastname: Reisch
authors.affiliation: Departments of Family Medicine and Public Health & Preventive Medicine, Oregon Health & Science University, Portland;
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Carney
authors.affiliation: From the Department of Medicine, University of Washington School of Medicine, Seattle;
authors.forename: Natalia V
authors.initials: NV
authors.lastname: Oster
authors.affiliation: Department of Pathology, University of Vermont and UVM Cancer Center, Burlington; and.
authors.forename: Donald L
authors.initials: DL
authors.lastname: Weaver
authors.affiliation: Departments of Medical Informatics and Clinical Epidemiology and Medicine, Oregon Health & Science University, and Providence Cancer Center, Providence Health & Services, Portland.
authors.forename: Heidi D
authors.initials: HD
authors.lastname: Nelson
authors.affiliation: From the Department of Medicine, University of Washington School of Medicine, Seattle;
authors.forename: Paul D
authors.initials: PD
authors.lastname: Frederick
authors.affiliation: From the Department of Medicine, University of Washington School of Medicine, Seattle; jelmore@uw.edu.
authors.forename: Joann G
authors.initials: JG
authors.lastname: Elmore
mesh_terms: D001291:Attitude of Health Personnel; D003675:Defensive Medicine; D005260:Female; D006801:Humans; D008297:Male; D010338:Pathology, Clinical; D010820:Physicians; D011795:Surveys and Questionnaires
keywords: Assurance behaviors; Breast; Breast pathology; Defensive medicine; Medical malpractice