News: ED providers more worried about patient harm than lawsuits, survey shows

In Massachusetts acute care hospitals, the average emergency department (ED) attending physician and advanced practice clinician  is more afraid of harming patients than about lawsuits, according to a new research letter published in JAMA Network Open. Fear of harm was also higher than fear of lawsuit regardless of clinician type, experience, or sex. These findings contradict previous research interpretations that providers practice doing more tests and providing more referrals to defend themselves against malpractice suits, MedPage Today reported.

The results came from a survey that used a Likert scale of one (strongly disagree) to six (strongly agree), with 1,222 ED providers (physicians, nurse practitioners, or physician assistants). When asked to rate how much they agreed with the statement, “In my day-to-day practice, I am fearful of making a mistake which results in harm to the patient,” the mean score for providers was 4.4, while the score was 3.4 for the statement, “In my day-to-day practice, I am fearful of making a mistake which results in being sued.” The score remained similar whether the survey was completed before or after the COVID-19 pandemic started.

“When we look at defensive medicine, a lot of times people are really just focusing on a limited number of variables, and right at the top of the list, everyone thinks that doctors are ordering lots of tests because they're afraid of malpractice," Linda M. Isbell, PhD, of the University of Massachusetts Amherst, told MedPage Today. "And we're saying, actually, you can imagine a doctor who is just really afraid of harming people—a lot of doctors are—and they don't care that much about malpractice.”

Reasons for excess testing are varied, ranging from uncertainty in diagnoses, to gaps in training, to patient expectations and financial incentives. The study showed that years of experience in their practice did affect providers’ scores, but further research with other populations and settings is needed, Isbell and colleagues noted.

Editor’s note: To read MedPage Today’s coverage of this story, click here. To read the JAMA Network Open research letter, click here.