Does the Fear of a Malpractice Suit Change How Dermapathologists Practice?

A study in The Journal of the American Academy of Dermatology (JAAD) suggests that the possibility of a medical malpractice lawsuit haunts even those who have never faced one.

The purpose of the study was to identify characteristics associated with past malpractice lawsuits and how malpractice concerns may affect interpretive practices among dermatopathologists. This is an area of concern for practitioners who potentially overlap with oncology. While dermatologists are typically among the least pursued practitioners, data from the New England Journal of Medicine and others suggest that oncologists are among the physicians who face the most malpractice cases, significantly below but uncomfortably close to surgeons across multiple specialties.

An earlier study in the American Journal of Clinical Pathology found that breast pathologists routinely engage in what is known as “assurance behaviors” -- such as ordering additional stains or surgical sampling, obtaining second reviews, or choosing the more severe diagnosis for borderline cases -- even when there is limited medical value in doing so.

In the JAAD study, researchers surveyed 207 of 301 (68.8%) eligible dermatopathologists who interpret melanocytic skin lesions in 10 states. The survey assessed the practitioners’ demographic and clinical practice characteristics, perceptions of how medical malpractice concerns could influence their interpretive practices, and past malpractice lawsuits. One-third of the dermatopathologists surveyed reported past malpractice experiences.

The study identified certain factors associated with being sued, including older age (57 vs. 48 years, P < .001), lack of board certification or fellowship training in dermatopathology (76.5% vs 53.2%, P = .001), and greater number of years interpreting melanocytic lesions (>20 years: 52.9% vs 20.1%, P < .001).

The respondents were generally confident in their melanocytic interpretations: 64% reported being moderately or extremely confident. But most also indicated that, similar to the results of the AJCP study, malpractice concerns increased their likelihood of ordering specialized pathology tests, obtaining recuts, and seeking a second opinion. Interestingly, among the dermapathologists who had faced a malpractice lawsuit, none of them indicated that failure to perform any of those tasks resulted in the malpractice claim.

Limitations of this study include lack of validation of and details about the malpractice suits experienced by participating dermatopathologists. In addition, the study assessed perceptions of practice rather than actual practices that might be associated with malpractice incidents.