Does Medical Malpractice Reform Change Practice Patterns?
Learning Objectives and CME/Disclosure Information
This activity is intended for healthcare providers delivering care to women and their families.
After completing this activity, the participant should be better able to:
1. Discuss the potential role of defensive medicine in the recommending of a diagnostic test or medical treatment 2. Describe how some states laws have been changed to cap noneconomic damages such as pain and suffering in medical malpractice claims and the evidence as to whether these reforms have affected medical practice
Estimated time to complete activity: 0.25 hours
Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project
Disclosure of Conflicts of Interest
Postgraduate Institute for Medicine (PIM) requires faculty, planners, and others in control of educational content to disclose all their financial relationships with ineligible companies. All identified conflicts of interest (COI) are thoroughly vetted and mitigated according to PIM policy. PIM is committed to providing its learners with high quality accredited continuing education activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of an ineligible company.
The PIM planners and others have nothing to disclose. The OBG Project planners and others have nothing to disclose.
Faculty: Susan J. Gross, MD, receives consulting fees from Cradle Genomics, and has financial interest in The ObG Project, Inc.
Planners and Managers: The PIM planners and managers, Trace Hutchison, PharmD, Samantha Mattiucci, PharmD, CHCP, Judi Smelker-Mitchek, MBA, MSN, RN, and Jan Schultz, MSN, RN, CHCP have nothing to disclose.
Method of Participation and Request for Credit
Fees for participating and receiving CME credit for this activity are as posted on The ObG Project website. During the period from August 7 2018 through Jan 25 2023, participants must read the learning objectives and faculty disclosures and study the educational activity.
If you wish to receive acknowledgment for completing this activity, please complete the post-test and evaluation. Upon registering and successfully completing the post-test with a score of 100% and the activity evaluation, your certificate will be made available immediately.
For Pharmacists: Upon successfully completing the post-test with a score of 100% and the activity evaluation form, transcript information will be sent to the NABP CPE Monitor Service within 4 weeks.
Joint Accreditation Statement
In support of improving patient care, this activity has been planned and implemented by the Postgraduate Institute for Medicine and The ObG Project. Postgraduate Institute for Medicine is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.
Physician Continuing Medical Education
Postgraduate Institute for Medicine designates this enduring material for a maximum of 0.25 AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
Continuing Nursing Education
The maximum number of hours awarded for this Continuing Nursing Education activity is 0.2 contact hours.
Medical malpractice claims began to rise in the 1960s, likely driven by new and more complex treatments with higher risks of iatrogenic harm and changes in liability law. The increase in such claims led organized medical groups to request reforms to medical liability laws. These groups asserted that recommending a diagnostic test or medical treatment that is not necessarily the best option for the patient, but rather an option that serves to protect the physician against claims of malpractice with the patient as potential plaintiff (also known as ‘defensive medicine’), was unnecessarily increasing costs of healthcare. Some states, in response, have adopted damage caps on noneconomic damages such as pain and suffering.
Researchers (JAMA Cardiology, 2018) studied the question of whether tort reform has changed physician behavior for specific conditions involving clinical uncertainty such as coronary artery disease (CAD), a leading cause of death in the US. The research found that physicians in states with caps on noneconomic damages performed testing at the same rate in states without caps. But the testing was less invasive (meaning fewer initial angiographies and less progression from initial stress test to angiography), and revascularization through PCI following initial testing declined. It appears that physicians in states with capped noneconomic damages are willing to tolerate greater clinical uncertainty in CAD testing and treatment if they face lower malpractice risk.
Furthermore, some authors (PloS One, 2018) looked at whether there is a connection between the increase in thyroid cancer incidence and the malpractice climate. They suggest that this increase is “a product of greater defensive medicine in states with higher malpractice risk, which leads to increased diagnostic testing of patients with thyroid nodules and potential overdiagnosis.”
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Disclosure of Unlabeled Use
This educational activity may contain discussion of published and/or investigational uses of agents that are not indicated by the FDA. The planners of this activity do not recommend the use of any agent outside of the labeled indications.
The opinions expressed in the educational activity are those of the faculty and do not necessarily represent the views of the planners. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.
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presented in this activity is not meant to serve as a guideline for patient management. Any procedures, medications, or other courses of diagnosis or treatment discussed or suggested in this activity should not be used by clinicians without evaluation of their patient’s conditions and possible contraindications and/or dangers in use, review of any applicable manufacturer’s product information, and comparison with recommendations of other authorities.
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