A recent study reported that approximately 9 of 10 US physicians practice defensive medicine to avoid malpractice claims, which cost the United States an estimated $56 billion per year. However, it is not clear whether being named in a malpractice claim has a considerable effect on a physician’s practice patterns. A study published in the Annals of Emergency Medicine attempted to identify changes in the practice patterns of emergency department physicians after being named in a malpractice claim.

Physicians who receive a malpractice claim may experience “medical malpractice stress syndrome,” leading them to practice defensively and sometimes causing them to order unnecessary treatments and tests to avoid future claims. The researchers of the study chose to focus on emergency department physicians, as they have fewer barriers to practicing defensively and perceive themselves to be at a higher risk for malpractice claims than other specialties. Using commonly measured markers of provider practice such as care intensity, care speed, and patient assessment of their experience with the emergency physician, the study aimed to examine which behaviors changed, if any, and how. The researchers compared 65 physicians named in malpractice claims with 140 matched control individuals. Using difference-in-difference methods, the researchers analyzed more than 1 million emergency department visits between the named physicians and matched control individuals from 2010 to 2015. Of the reported claims, most involved a neurological condition and alleged a failure to diagnose.

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The study found that after an emergency physician had been named in a malpractice lawsuit, there were no consistent changes except in Press Ganey percentile ranks, which assessed patients’ experiences with their physician. Relative to the control physicians, the named physicians had improved patient experience scores, beginning after filing and continuing into the postclaim period. Although the data showed that patient experience improved after physicians were named in a claim, there were no data to indicate how specific clinical actions were affected. In addition, there were very few female physicians included in the data set, which indicates that additional study could be pursued to determine whether physician gender may be a factor in practice pattern changes. Lastly, only emergency department physicians were included in the study, implying that further research could be performed to determine the practice patterns of other physician populations named in malpractice claims.

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Carlson JN, Foster KM, Black BS, et al. Emergency physician practice changes after being named in a malpractice claim [published ahead of print October 15, 2019]. Ann Emerg Med. doi:10.1016/j.annemergmed.2019.07.007