How concerns and experiences with medical malpractice affect dermatopathologists' perceptions of their diagnostic practices when interpreting cutaneous melanocytic lesions

作者：Carney Patricia A^*; Frederick Paul D; Reisch Lisa M; Knezevich Stevan; Piepkorn Michael W; Barnhill Raymond L; Elder David E; Geller Berta M; Titus Linda; Weinstock Martin A; Nelson Heidi D; Elmore Joann G

来源：Journal of the American Academy of Dermatology, 2016, 74(2): 317-324.

DOI：10.1016/j.jaad.2015.09.037

• additional histology testing
• clinical interpretation
• defensive clinical practice
• dermatopathology
• medical malpractice
• melanoma

Objective: We sought to identify characteristics associated with past malpractice lawsuits and how malpractice concerns may affect interpretive practices.
Methods: We surveyed 207 of 301 (68.8%) eligible dermatopathologists who interpret melanocytic skin lesions in 10 states. The survey assessed dermatopathologists' demographic and clinical practice characteristics, perceptions of how medical malpractice concerns could influence their interpretive practices, and past malpractice lawsuits.
Results: Of dermatopathologists, 33% reported past malpractice experiences. Factors associated with being sued included older age (57 vs 48 years, P < .001), lack of board certification or fellowship training in dermatopathology (76.5% vs 53.2%, P = .001), and greater number of years interpreting melanocytic lesions (>20 years: 52.9% vs 20.1%, P < .001). Of participants, 64% reported being moderately or extremely confident in their melanocytic interpretations. Although most dermatopathologists believed that malpractice concerns increased their likelihood of ordering specialized pathology tests, obtaining recuts, and seeking a second opinion, none of these practices were associated with past malpractice. Most dermatopathologists reported concerns about potential harms to patients that may result from their assessments of melanocytic lesions.
Limitations: Limitations of this study include lack of validation of and details about the malpractice suits experienced by participating dermatopathologists. In addition, the study assessed perceptions of practice rather than actual practices that might be associated with malpractice incidents.
Conclusions: Most dermatopathologists reported apprehension about how malpractice affects their clinical practice and are concerned about patient safety irrespective of whether they had actually experienced a medical malpractice suit.

• 出版日期2016-2