Perception of Malpractice Risk is Contagious Among Colleagues Interview with:

Dan LyPh.D. Program in Health PolicyHarvard

Dan Ly

Dan Ly, MD, MPP
Ph.D. Program in Health Policy
Harvard What is the background for this study?

Response: There is some mixed evidence regarding whether state level tort reform reduces defensive medicine, or the practicing of medicine in such a way to reduce medical liability. This includes “positive” defensive medicine, or performing certain tests and procedures to reduce such liability. Other research finds that the perception of malpractice risk drives such defensive medicine, including the use of diagnostic imaging, such as CT scans and MRIs.

I was interested in exploring what influenced the perception of this risk, hypothesizing that, for a physician, a report of an injury against one’s colleague might increase the perception of this risk and lead to an increase the use of diagnostic imaging. What are the main findings? 

Response: I found rates of diagnostic imaging increased by about a third for a physician whose colleague had a report of an injury against him or her, but this increase did not persist. I also found that injuries resulting in death led to larger increases in imaging than those that did not result in death. What should readers take away from your report? 

Response: These results are consistent with this prior research that finds that the perception of malpractice risk may be a large driver of defensive medicine. What recommendations do you have for future research as a result of this work? 

Response: I think one avenue of research might look into other influences on the perception of malpractice risk. Another avenue might try to separate defensive imaging due to fear of malpractice suits from imaging due to differences across physicians in how they perceive the risk of certain outcomes. That is, some physicians may be greatly concerned about an adverse outcome, even though the actual risk of a certain outcome based on the patient and how they present may be small. Other physicians might more accurately judge the risk to be small and therefore be less likely to use diagnostic tests to confirm this assessment. Is there anything else you would like to add?

Response: I’d like to thank the National Institute on Aging for grant support (F32 AG060650-01). The content of my article and this interview do not necessarily represent the official views of the National Institute on Aging, and this grant support played no role in how this study was conducted.


Ly DP. Rates of Advanced Imaging by Practice Peers After Malpractice Injury Reports in Florida, 2009-2013. JAMA Intern Med. Published online May 20, 2019. doi:10.1001/jamainternmed.2019.0163

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May 22, 2019 @ 11:00 am 

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