Over 75% of neurosurgeons practicing defensive medicine


More than three-fourths of US neurosurgeons practice some form of defensive medicine--performing additional tests and procedures out of fear of malpractice lawsuits.

This is according to an article in the February issue of Neurosurgery, the official journal of the Congress of Neurological Surgeons.

It said the rates and costs of defensive medicine by neurosurgeons are especially high in states with high-risk liability environments.

"Although ordering extra laboratory tests, imaging studies, etc. was prevalent everywhere, it was even more so in high-risk states," said Dr Timothy Smith, who conducted a survey of 1000 surgeons with colleagues from Northwestern University, Chicago.

More than 80 percent of surgeons said they had ordered imaging tests solely for defensive reasons, while more than three-fourths reported ordering laboratory tests and making extra referrals for defensive purposes. Up to half said they ordered more medications and procedures out of fear of being sued.

Rates of all of these defensive behaviors were higher for neurosurgeons in high-risk states. This included a 30 percent increase in the likelihood of ordering additional imaging studies for defensive purposes, 40 percent for additional laboratory tests.

Nearly half of neurosurgeons in high-risk states said they had stopped performing high-risk procedures because of liability concerns. Nearly one-fourth had stopped performing brain surgery for fear of being sued, while close to 40 percent were considering retirement because of the local liability environment.

“Neurosurgeons in high-risk states paid almost twice as much in malpractice insurance premiums as those in low-risk states. Across states, most neurosurgeons believed their malpractice coverage was inadequate. Malpractice premiums cost 15 to 20 percent of the neurosurgeons' annual income,” said the report. 

US, Risk Management, Dr Timothy Smith, Insurance