Linda J Titus1, Lisa M Reisch2, Anna N A Tosteson3, Heidi D Nelson4, Paul D Frederick2, Patricia A Carney5, Raymond L Barnhill6, David E Elder7, Martin A Weinstock8,9, Michael W Piepkorn10,11, Joann G Elmore12. 1. Department of Epidemiology and Pediatrics, Norris Cotton Cancer Center, Hanover, NH. 2. Department of Medicine, Norris Cotton Cancer Center, Hanover, NH. 3. Departments of Medicine and Community and Family Medicine, Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Norris Cotton Cancer Center, Hanover, NH. 4. Departments of Medical Informatics and Clinical Epidemiology and Medicine, Portland. 5. Department of Family Medicine, Oregon Health and Science University, Portland. 6. Department of Pathology, Institut Curie, Paris Sciences and Letters Research University, University of Paris Descartes, Paris, France. 7. Department of Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia. 8. Center for Dermatoepidemiology, VA Medical Center, Providence Department of Dermatology, Rhode Island Hospital, Providence. 9. Departments of Dermatology and Epidemiology, Brown University, Providence, RI. 10. Division of Dermatology, Department of Medicine, University of Washington School of Medicine, Seattle. 11. Dermatopathology Northwest, Bellevue, WA. 12. Department of Medicine, University of California, Los Angeles, David Geffen School of Medicine, Los Angeles, CA.
Abstract
OBJECTIVES: The impact of malpractice concerns on pathologists' use of defensive medicine and interpretations of melanocytic skin lesions (MSLs) is unknown. METHODS: A total of 207 pathologists interpreting MSLs responded to a survey about past involvement in malpractice litigation, influence of malpractice concerns on diagnosis, and use of assurance behaviors (defensive medicine) to alleviate malpractice concerns. Assurance behaviors included requesting second opinions, additional slides, additional sampling, and ordering specialized tests. RESULTS: Of the pathologists, 27.5% reported that malpractice concerns influenced them toward a more severe MSL diagnosis. Nearly all (95.2%) pathologists reported practicing at least one assurance behavior due to malpractice concerns, and this practice was associated with being influenced toward a more severe MSL diagnosis (odds ratio, 2.72; 95% confidence interval, 1.41-5.26). CONCLUSIONS: One of four US skin pathologists upgrade MSL diagnosis due to malpractice concerns, and nearly all practice assurance behaviors. Assurance behaviors are associated with rendering a more severe MSL diagnosis.
OBJECTIVES: The impact of malpractice concerns on pathologists' use of defensive medicine and interpretations of melanocytic skin lesions (MSLs) is unknown. METHODS: A total of 207 pathologists interpreting MSLs responded to a survey about past involvement in malpractice litigation, influence of malpractice concerns on diagnosis, and use of assurance behaviors (defensive medicine) to alleviate malpractice concerns. Assurance behaviors included requesting second opinions, additional slides, additional sampling, and ordering specialized tests. RESULTS: Of the pathologists, 27.5% reported that malpractice concerns influenced them toward a more severe MSL diagnosis. Nearly all (95.2%) pathologists reported practicing at least one assurance behavior due to malpractice concerns, and this practice was associated with being influenced toward a more severe MSL diagnosis (odds ratio, 2.72; 95% confidence interval, 1.41-5.26). CONCLUSIONS: One of four US skin pathologists upgrade MSL diagnosis due to malpractice concerns, and nearly all practice assurance behaviors. Assurance behaviors are associated with rendering a more severe MSL diagnosis.
Authors: Emily R Carrier; James D Reschovsky; Michelle M Mello; Ralph C Mayrell; David Katz Journal: Health Aff (Millwood) Date: 2010-09 Impact factor: 6.301
Authors: David M Studdert; Michelle M Mello; William M Sage; Catherine M DesRoches; Jordon Peugh; Kinga Zapert; Troyen A Brennan Journal: JAMA Date: 2005-06-01 Impact factor: 56.272
Authors: Jason P Lott; Denise M Boudreau; Ray L Barnhill; Martin A Weinstock; Eleanor Knopp; Michael W Piepkorn; David E Elder; Steven R Knezevich; Andrew Baer; Anna N A Tosteson; Joann G Elmore Journal: JAMA Dermatol Date: 2018-01-01 Impact factor: 10.282
Authors: Lisa M Reisch; Patricia A Carney; Natalia V Oster; Donald L Weaver; Heidi D Nelson; Paul D Frederick; Joann G Elmore Journal: Am J Clin Pathol Date: 2015-12 Impact factor: 2.493
Authors: Patricia A Carney; Paul D Frederick; Lisa M Reisch; Stevan Knezevich; Michael W Piepkorn; Raymond L Barnhill; David E Elder; Berta M Geller; Linda Titus; Martin A Weinstock; Heidi D Nelson; Joann G Elmore Journal: J Am Acad Dermatol Date: 2015-11-11 Impact factor: 11.527
Authors: Lisa M Reisch; Martiniano J Flores; Andrea C Radick; Hannah L Shucard; Kathleen F Kerr; Michael W Piepkorn; Raymond L Barnhill; David E Elder; Stevan R Knezevich; Joann G Elmore Journal: Am J Clin Pathol Date: 2020-10-13 Impact factor: 2.493
Authors: Caitlin J May; Michael W Piepkorn; Stevan R Knezevich; David E Elder; Raymond L Barnhill; Annie C Lee; Martiniano J Flores; Kathleen F Kerr; Lisa M Reisch; Joann G Elmore Journal: J Cutan Pathol Date: 2020-07-17 Impact factor: 1.587
Authors: Ian Katz; Blake O'Brien; Simon Clark; Curtis T Thompson; Brian Schapiro; Anthony Azzi; Alister Lilleyman; Terry Boyle; Lore Jane L Espartero; Miko Yamada; Tarl W Prow Journal: JAMA Netw Open Date: 2021-12-01