Malpractice fears, patient safety influence dermatopathologists

Concern for patients along with malpractice fears influence dermatopathologists’ actions in ordering additional tests and services in melanocytic skin lesions, according to a study.

“There’s long been concerns that we physicians alter our behaviors and practices and ordering of tests due to fear of being sued,” study author Joann G. Elmore, MD, MPH, told Healio. “The dermatopathologist specialty ranks quite high in malpractice cases and expensive verdicts.”

An online survey of 160 dermatopathologists from 33 U.S. states asked responding physicians questions regarding their clinical behaviors and motivations.

Five clinical behaviors were identified: ordering additional immunohistochemistry or molecular tests, recommending additional surgical tests, requesting additional slides cut from the block, requesting more second opinions and adding caveats in reports regarding difficulty of lesions.

In all, 95% reported doing at least one of the five behaviors due to malpractice concerns, while 99% reported doing so because of patient safety concerns.

Twenty percent of participants said they order additional tests due to patient safety exclusively, while 1% reported they do so exclusively out of malpractice concerns.

Malpractice concerns were reported as the motivation for more surgical samples in 78% of respondents, while patient safety was reported as the motivation in 91% of participants.

“We realized that indeed we might be influenced by fear of malpractice, but deep down as physicians, we care about patients,” Elmore said. “We care about quality, and we care about safety.”