Malpractice litigation is a major concern when medical errors result in adverse patient outcomes, Ostrovsky, et al. (2022) report. They add, "Fear of malpractice has been associated with excessive healthcare use through defensive medicine, whereby additional testing or referrals are made to protect physicians from malpractice accusations. Although fear of lawsuits and its implications for decision-making have been well studied, few investigators have examined clinicians' concern regarding causing patient harm, which might be a stronger impetus for excessive testing."

This cross-sectional study investigated emergency department (ED) clinicians' concerns about medical errors resulting in either patient harm or malpractice litigation.

The researchers conducted an online survey targeting all ED attending physicians and advanced practice clinicians (APCs) in acute-care hospitals across Massachusetts from January to September 2020.

Respondents used a Likert scale of 1 (strongly disagree) to 6 (strongly agree) to indicate degree of agreement with two statements: “In my day-to-day practice, I am fearful of making a mistake which results in [1] harm to the patient” (fear of harm) and “[2] being sued” (fear of suit). Respondents reported their age, race and ethnicity, number of shifts per month, percentage of night shifts, years of experience, and salary type. Two-sided P < .05 indicated significance. R, version 4.1.2 (R Core Team), was used for analyses.

Respondents included 1,222 clinicians (mean [SD] age, 43.3 [10.6] years; 608 men [54.2%], 506 women [45.1%], 8 other gender [0.7%]). Response rates were similar for physicians (77.2%) and APCs (75.8%). The Table shows respondent characteristics.

Mean score was greater for fear of harm than fear of suit (4.40 vs 3.40; P < .001). Mean fear-of-harm score was similar regardless of survey completion before or after the COVID-19 pandemic started (4.42 vs 4.39; P = .70). No difference was found in mean fear-of-suit score before vs after the pandemic started, (3.41 vs 3.38; P = .70). Modal responses were moderately agree to fear-of-harm (31.1% [n = 349]) and slightly agree to fear-of-suit (29.1% [n = 327]) questions. Fear-of-harm scores were higher than fear-of-suit scores, regardless of clinician subtype, experience, or sex (Figure), and positively correlated (Pearson r = 0.53; P < .001).

In multivariable linear regressions, adjusted fear-of-harm score differed between respondents with 5 to 14 years of experience (regression coefficient [β] = –0.25; P = .009) and 15 to 44 years of experience (β = –0.38; P < .001) vs respondents with 0 to 4 years of experience. Differences emerged for physicians vs APCs (β = –0.30; P < .001) and male vs female respondents (β = –0.17, P = .03). Fear-of-suit score differed between respondents with 5 to 14 years of experience (β = –0.35; P < .001) and 15 to 44 years of experience (β = –0.72; P < .001) vs those with 0 to 4 years of experience and for physician vs APCs (β = –0.18; P = .053). Statistical differences by sex were not detected.

Reference: Ostrovsky D, et al. Perspectives of Emergency Clinicians About Medical Errors Resulting in Patient Harm or Malpractice Litigation. JAMA Netw Open. 2022;5(11):e2241461. doi:10.1001/jamanetworkopen.2022.41461