Malpractice Concerns, Defensive Medicine, and the Histopathology Diagnosis of Melanocytic Skin Lesions

Linda J. Titus, Lisa M. Reisch, Anna N.A. Tosteson, Heidi D. Nelson, Paul D. Frederick, Patricia A. Carney, Raymond L. Barnhill, David E. Elder, Martin A. Weinstock, Michael W. Piepkorn, Joann G. Elmore

Research output: Contribution to journalArticle

3 Scopus citations

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.

Original languageEnglish (US)
Pages (from-to)338-345
Number of pages8
JournalAmerican journal of clinical pathology
Volume150
Issue number4
DOIs
StatePublished - Aug 30 2018

Keywords

  • Assurance behaviors
  • Defensive medicine
  • Diagnosis
  • Medical malpractice
  • Melanocytic skin lesions
  • Melanoma
  • Skin pathology

ASJC Scopus subject areas

  • Pathology and Forensic Medicine

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    Titus, L. J., Reisch, L. M., Tosteson, A. N. A., Nelson, H. D., Frederick, P. D., Carney, P. A., Barnhill, R. L., Elder, D. E., Weinstock, M. A., Piepkorn, M. W., & Elmore, J. G. (2018). Malpractice Concerns, Defensive Medicine, and the Histopathology Diagnosis of Melanocytic Skin Lesions. American journal of clinical pathology, 150(4), 338-345. https://doi.org/10.1093/ajcp/aqy057