Research Results Show Correlation Between States’ Medical-Legal Risk Environments and the Practice of Defensive Neurosurgical Medicine

Newswise — Miami (April 17, 2012) — For the first time, a nationwide survey of neurosurgical defensive practices was conducted by researchers to see whether a state’s medical legal-risk environment correlates with defensive neurosurgical medicine. The results of that survey, revealed today at the 80th Annual Scientific Meeting of the American Association of Neurological Surgeons (AANS) in Miami, suggest that not only do neurosurgeons correctly perceive the medical-legal environs in which they practice, but that these perceptions have far-ranging effects on both neurosurgical practitioners and the patients they serve.

High-risk medical specialties such as neurosurgery often are predominated by both avoidant and assurance defensive medical practices. Various states within the United States have wide-ranging medical-legal environments that present different liability risks for practitioners. But it had yet to be shown if a state’s medical-legal risk environment actually corresponds with defensive medicine. This study — The Relationship of State Medical-Legal Risk Environment to Defensive Medicine in Neurosurgery — is the first to look at neurosurgical defensive practices on a national level. The results of the survey will be presented by Timothy R. Smith, MD, PhD, 4:00-4:08 p.m., on Tuesday, April 17. Co-authors are Christopher Getch, MD, FAANS; Maya Babu, MD, MBA; Brian Nahed, MD; Robert Heary, MD, FAANS; and Hunt Batjer, MD, FAANS, FACS.

A validated 51-question online survey was sent to 3,344 practicing U.S. neurosurgeons, all of whom were members of the AANS, which represented some 76 percent of neurosurgeons in academic and private practice. The responses were then classified to state-by-state medical-legal risk environments using multivariate regression models. The survey yielded 1,028 respondents, a response rate of 31 percent. Of those responding, more than two-thirds reported engaging in both assurance and avoidant behaviors due to concerns about liability. State medical-legal risk environment was a telling predictor of response rate, the number of neurosurgeons per population, perceptions of patient as a potential lawsuit, perception of liability burden, insurance premiums, the adoption of asset protection strategies, and assurance and avoidant behaviors in the previously mentioned multivariate logistic regression models (p<.05).

Based on these results, the researchers have concluded that U.S. neurosurgeons not only recognize the various liability risks that exist in different states, but their perception of those risks have led to decreased neurological services, fewer numbers of neurosurgeons, greater suspicion by patients, higher insurance premiums, and increased levels of defensive behaviors in high-risk states. The researchers also conclude that those states with high liability risk profiles are associated with more waste, less service and likely higher costs of health-care delivery.

Disclosure: the author reports no conflicts of interest.

The 2012 AANS Annual Meeting press kit includes releases on highlighted scientific research, AANS officer and award winners, and National Neurosurgery Awareness Week. These releases will be posted under Media/Press on the 2012 AANS Annual Meeting website page. Additional information about the AANS Annual Meeting and the Meeting Program is available by clicking here.

Media Representatives: If you would like to cover the meeting or interview a neurosurgeon — either on-site or via telephone — please contact John Iwanski, AANS Director of Member and Public Outreach, at 847-378-0517, or call the Annual Scientific Meeting Press Room beginning Monday, April 16 at 786-276-4501.

Founded in 1931 as the Harvey Cushing Society, the American Association of Neurological Surgeons (AANS) is a scientific and educational association with more than 8,100 members worldwide. The AANS is dedicated to advancing the specialty of neurological surgery in order to provide the highest quality of neurosurgical care to the public. All active members of the AANS are certified by the American Board of Neurological Surgery, the Royal College of Physicians and Surgeons (Neurosurgery) of Canada or the Mexican Council of Neurological Surgery, AC. Neurological surgery is the medical specialty concerned with the prevention, diagnosis, treatment and rehabilitation of disorders that affect the entire nervous system including the spinal column, spinal cord, brain and peripheral nerves. For more information, visit www.AANS.org.