International Defensive Medicine in Neurosurgery: A Comparison of Canada, South Africa, and the United States

• Published in: World neurosurgery Vol. 95; pp. 53 - 61
• Main Authors: Yan, Sandra C., BS, BA, Hulou, M. Maher, MD, Cote, David J., BS, Roytowski, David, MD, Rutka, James T., MD, PhD, FRCSC, FACS, FAAP, Gormley, William B., MD, MPH, Smith, Timothy R., MD, PhD, MPH
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2016
• Subjects: Canada; Defensive Medicine - statistics & numerical data; Female; Humans; Insurance, Liability - economics; Liability, Legal; Logistic Models; Male; Malpractice; Medico-legal environment; Multivariate Analysis; Neurosurgery; Practice Patterns, Physicians' - statistics & numerical data; South Africa; Surveys and Questionnaires; United States; Canada; MPS; Canadian Medical Protective Association; CMPA; United States; Medical Protection Society; South Africa; medico-legal environment; U.S; neurosurgery; Medico-legal environment; Neurosurgery
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2016.07.069

Abstract Objective Perception of medico-legal risk has been shown to influence defensive medicine behaviors. Canada, South Africa, and the U.S. have three vastly different healthcare and medico-legal systems. There has been no previous study comparing defensive medicine practices internationally. Methods An online survey was sent to 3,672 neurosurgeons across Canada, South Africa, and the U.S. The survey included questions on the following domains: surgeon demographics, patient characteristics, physician practice type, surgeon liability profile, defensive behavior – including questions on the frequency of ordering additional imaging, laboratory tests, and consults – and perception of the liability environment. Responses were analyzed, and multivariate logistic regression was used to examine the correlation of medico-legal risk environment and defensive behavior. Results The response rate was 30.3% in the U.S. (n=1,014), 36.5% in Canada (n=62), and 41.8% in South Africa (n=66). Canadian neurosurgeons reported an average annual malpractice premium of $19,110 (SD=$11,516), compared to $16,262 (SD=$7,078) for South African respondents, $75,857 (SD=$50,775) for neurosurgeons from low-risk U.S. states, and $128,181 (SD=$79,355) for those from high-risk U.S. states. Neurosurgeons from South Africa were 2.8 times more likely to engage in defensive behaviors compared to Canadian neurosurgeons, while neurosurgeons from low-risk U.S. states were 2.6 times more likely. Neurosurgeons from high-risk U.S. states were 4.5 times more likely to practice defensively compared to Canadian neurosurgeons. Conclusions Neurosurgeons from the U.S. and South Africa are more likely to practice defensively than neurosurgeons from Canada. Perception of medico-legal risk is correlated with reported neurosurgical defensive medicine within these countries.