Malpractice concerns increase the likelihood that dermatopathologists who interpret melanocytic skin lesions will order more specialized pathology tests, obtain recuts, and seek a second opinion, according to a study that surveyed dermatopathologists in different states. However, the analysis found no evidence that such practice behaviors were influenced by personal medical malpractice experience.
The results of the study, published online on Nov. 7 in the Journal of the American Academy of Dermatology, suggest that fear of lawsuits influences dermatopathologists’ interpretive behavior, regardless of actual past litigation.
Dr. Patricia A. Carney of Oregon Health and Science University, Portland, and her colleagues surveyed 207 dermatopathologists in 10 states who interpret melanocytic skin lesions. They assessed dermatopathologists’ demographic and clinical practice characteristics, perceptions of how medical malpractice concerns influence their practices, and doctors’ past litigation experiences. The majority were male (59%), had no affiliations with academic medical centers (71.5%), and had not been board certified or fellowship trained in dermatopathology (61%).
Of the 207 dermatopathologists, 67% reported no previous malpractice claims against them, and 33% reported one case or more. Physician characteristics associated with having a malpractice claim included older age and lack of board certification or fellowship training in dermatopathology.
Clinical practice characteristics associated with having a past malpractice claim included a greater number of years interpreting melanocytic lesions, lower representation of melanocytic lesions in their caseloads, a higher frequency of providing second opinions on melanocytic lesions, and being considered an expert in assessment of melanocytic lesions by colleagues. About 70% said that interpreting melanocytic skin lesions made them more nervous than other types of pathology, and nearly 75% agreed with the statement that they were concerned about patient safety and “potential harm to patients” that could result from their assessment of melanocytic lesions.
However, 64% of those surveyed said they were “moderately or extremely confident” in their melanocytic interpretations.
Of those surveyed, 92% reported that medical malpractice concerns increased their requests for second opinions. These concerns also prompted requests for additional slides to be cut from tissue blocks in 87% of those surveyed, ordering that additional surgical samples be taken from patients in 66%, and choosing a more severe diagnosis for cases considered borderline in 53%. But the researchers found no evidence that having had a malpractice claim influenced any of these behaviors.
“Dermatopathologists, like other physicians, are likely well aware of malpractice and discuss these experiences among colleagues,” they wrote. “Thus, a lawsuit is not needed for dermatopathologists to be aware of and undertake behaviors that might protect them from a suit.”
The results, they added, “indicate that most dermatopathologists have concerns about patient harms associated with their interpretations of melanocytic lesions; thus, they are not just concerned for themselves.”
The authors note that as far as they know, this study is the first to evaluate “how dermatopathologists view their clinical practices are influenced by malpractice.”
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