Medical malpractice concerns and defensive medicine: A nationwide survey of breast pathologists

Lisa M. Reisch, Patricia A. Carney, Natalia V. Oster, Donald L. Weaver, Heidi D. Nelson, Paul D. Frederick, Joann G. Elmore

Research output: Contribution to journalReview articlepeer-review

32 Scopus citations


Objectives: "Assurance behaviors" in medical practice involve providing additional services of marginal or no medical value to avoid adverse outcomes, deter patients from filing malpractice claims, or ensure that legal standards of care were met. The extent to which concerns about medical malpractice influence assurance behaviors of pathologists interpreting breast specimens is unknown. Methods: Breast pathologists (n = 252) enrolled in a nationwide study completed an online survey of attitudes regarding malpractice and perceived alterations in interpretive behavior due to concerns of malpractice. Associations between pathologist characteristics and the impact of malpractice concerns on personal and colleagues' assurance behaviors were determined by χ2 and logistic regression analysis. Results: Most participants reported using one or more assurance behaviors due to concerns about medical malpractice for both their personal (88%) and colleagues' (88%) practices, including ordering additional stains, recommending additional surgical sampling, obtaining second reviews, or choosing the more severe diagnosis for borderline cases. Nervousness over breast pathology was positively associated with assurance behavior and remained statistically significant in a multivariable logistic regression model (odds ratio, 2.5; 95% confidence interval, 1.0-6.1; P =.043). Conclusions: Practicing US breast pathologists report exercising defensive medicine by using assurance behaviors due to malpractice concerns.

Original languageEnglish (US)
Pages (from-to)916-922
Number of pages7
JournalAmerican journal of clinical pathology
Issue number6
StatePublished - Dec 2015


  • Assurance behaviors
  • Breast
  • Breast pathology
  • Defensive medicine
  • Medical malpractice

ASJC Scopus subject areas

  • Pathology and Forensic Medicine


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