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PubMed1993

Defensive medicine.

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Defensive Medicine↗

PubMed1993

Defensive medicine.

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Defensive Medicine↗

PubMed1996

The use of low-osmolar contrast agents: technological change and defensive medicine.

The escalating cost of medical care in the United States, especially in the past decade, has resulted in efforts to identify the factors contributing to rising costs. One factor often assumed to cause higher medical costs is the physician's fear of liability for not using the latest available technology. In this article, we report the results of a case study we conducted to better understand the relationship between the introduction and use of one particular technology, low-osmolar contrast agents, and liability concerns. Our study suggests that both clinicians and administrators are primarily guided by the medical benefits of low-osmolar contrast agents, and that liability concerns, although widespread, are of secondary importance. The inability to control this and similar technologies is likely to put a far greater strain on the nation's health care resources than is the practice of defensive medicine. These findings may be helpful to health policy makers, physicians, administrators, and legislators considering choices for health care reform in general and for medical liability reform in particular.

Attitude of Health Personnel↗

PubMedDate not supplied

Clinical guidelines, defensive medicine, and the physician between the two.

PURPOSE: In this article, we study the use of the American Academy of Otolaryngology-Head and Neck Surgery recommendations regarding coagulation screening tests before tonsillectomy and adenoidectomy by ear, nose, and throat (ENT) physicians in Israel and offer insights into the reasons for accepting/declining this recommendation. MATERIALS AND METHODS: During April and May 2002, 309 self-administered questionnaires were sent to all ENT physician members of the Israeli Society of Otolaryngology-Head and Neck Surgery. Physicians answered questions regarding demographic data, their habits of preoperative laboratory and imaging tests before tonsillectomy and adenoidectomy, and the reasons for performing these tests. RESULTS: One hundred ninety-six (63.4% compliance rate) physicians responded to the survey. One hundred fifty-four (78.6% of the responding physicians) do not follow guideline recommendations and ask their otherwise healthy patients to undergo prothrombin time/partial thromboplastin time (PT/PTT) tests before tonsillectomy and adenoidectomy. Common practice in their departments was the leading reasoning for preoperative PT/PTT testing for 101 (51.5%) physicians. Eighty-nine physicians (45.4%) specifically stated that the reason for this behavior is defensive medicine, thirty-two physicians (16.3%) stated that the reason for those tests is hospital requirements, and literature recommendation was the reason in 24 (12.2%), followed by personal experience for 11 physicians (5.6%). CONCLUSIONS: Most ENT physicians in Israel do not follow clinical guidelines and perform unnecessary coagulation tests before tonsillectomy and adenoidectomy. More studies are needed to find ways to change physicians' behavior regarding preoperative tests.

Adenoidectomy↗

PubMed1989