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CMECNE

Does Medical Malpractice Reform Change Practice Patterns?

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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

Faculty:

Susan J. Gross, MD, FRCSC, FACOG, FACMG
President and CEO, The ObG Project

Disclosure of Conflicts of Interest

Postgraduate Institute for Medicine (PIM) requires instructors, planners, managers and other individuals who are in a position to control the content of this activity to disclose any real or apparent conflict of interest (COI) they may have as related to the content of this activity. All identified COI are thoroughly vetted and resolved according to PIM policy. PIM is committed to providing its learners with high quality CME activities and related materials that promote improvements or quality in healthcare and not a specific proprietary business interest of a commercial interest.

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 August 7 2021, 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.

Read Disclaimer & Fine Print

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.” 

Learn More – Primary Sources  

Association of Medical Liability Reform with Clinician Approach to Coronary Artery Disease Management

Lessons from a decade of technical-scientific opinions in obstetrical litigation 

Evidence of a positive association between malpractice climate and thyroid cancer incidence in the United States 

Take a post-test and get CME credits

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Related ObG Topics:

AMA Report: The Almost Inevitability of Medical Malpractice Lawsuits
You’ve Been Served, Part Four: An ObGyn Defendant Wins the Case – Guidelines Matter 

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This website (the “Website”) is a service made available by The ObG Project LLC, its partners, affiliates or subsidiaries (“Provider”). This Website provides general information related to the law and is designed to help users safely cope with their own legal needs. This website does not provide legal advice and Provider is not a law firm. None of our customer service representatives are lawyers and they also do not provide legal advice. Although we go to great lengths to make sure our information is accurate and useful, we recommend you consult a lawyer if you want legal advice. No attorney-client or confidential relationship exists or will be formed between you and Provider or any of our representatives.
This website is not intended to be a source for legal advice, and thus the reader should not rely on any information provided in this website as such. Readers should not consider the information provided to be an invitation for an attorney-client relationship, and should always seek the advice of competent counsel in the reader’s home jurisdiction. Provider may provide links to third party websites. These links are provided only as a convenience. Linked websites are not reviewed, controlled or examined by Provider and Provider is not responsible for the information, advertising, products, resources or other materials, of any linked site or any link contained in a linked site. The inclusion of any link does not imply endorsement by Provider. In addition, please be aware that your use of any linked site is subject to the terms and conditions applicable to that site. Please direct any questions regarding linked sites to the webmaster of that site.

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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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