Abstract
OBJECTIVE: Physician experts hired and prepared by the litigants provide most information on standard of care for medical malpractice cases. Since this information may not be objective or accurate, we examined the feasibility and potential value of surveying community physicians to assess standard of care.
DESIGN: Seven physician surveys of mutually exclusive groups of randomly selected physicians.
SETTING: Iowa.
PARTICIPANTS: Community and academic primary care physicians and relevant specialists.
INTERVENTIONS: Included in each survey was a case vignette of a primary care malpractice case and key quotes from medical experts on each side of the case. Surveyed physicians were asked whether the patient should have been referred to a specialist for additional evaluation. The 7 case vignettes included 3 closed medical malpractice cases, 3 modifications of these cases, and 1 active case.
MEASUREMENTS AND MAIN RESULTS: Sixty-three percent of 350 community primary care physicians and 51% of 216 community specialists completed the questionnaire. For 3 closed cases, 47%, 78%, and 88% of primary care physician respondents reported that they would have made a different referral decision than the defendant. Referral percentages were minimally affected by modifying patient outcome but substantially changed by modifying patient presentation. Most physicians, even those whose referral decisions were unusual, assumed that other physicians would make similar referral decisions. For each case, at least 65% of the primary care physicians disagreed with the testimony of one of the expert witnesses. In the active case, the response rate was high (71%), and the respondents did not withhold criticism of the defendant doctor.
CONCLUSIONS: Randomly selected peer physicians are willing to participate in surveys of medical malpractice cases. The surveys can be used to construct the distribution of physician self-reported practice relevant to a particular malpractice case. This distribution may provide more information about customary practice or standard of care than the opinion of a single physician expert.
Similar content being viewed by others
References
Drechsler CT. Duty of care: liability for malpractice. In: American Jurisprudence: Physicians, Surgeons and Other Healers, Vol 61, section 206, 2nd Ed. St Paul, Minn: West Press; 1999.
Danzon P. Medical Malpractice: Theory, Evidence, and Public Policy. Cambridge, Mass: Harvard University Press; 1985:140.
Danzon P. Medical Malpractice: Theory, Evidence, and Public Policy. Cambridge, Mass: Harvard University Press; 1985:149.
Meltzer N. Helling v. Carey: a landmark or exception in medical malpractice? New Eng L Rev. 1975;11:301–12.
Danzon P. Medical Malpractice: Theory, Evidence, and Public Policy. Cambridge, Mass: Harvard University Press; 1985:144.
Hall MA. The defensive effect of medical practice policies in malpractice litigation. Law Contemp Probs. 1991;54:119–45.
Jones v. Chidester. Atlantic Reporter, 2nd Series, Vol 610. St. Paul, Minn: West Publishing, Inc.; 1992;964–70.
Gross SR. Expert evidence. Wis L Rev. 1991;1991:1113–232.
Boyarsky S. Practical Measures to Reduce Medical Expert Witness Bias. J Forensic Sci. 1989;34:1259–65.
Fisher CW, Dombrowski MP, Jaszczak SE, Cook CD, Sokol RJ. The expert witness: real issues and suggestions. Am J Obstet Gynecol. 1995;172:1792–800.
American Medical Association. Proceedings of the House of Delegates, 52nd Interim Meeting, December 1998. Chicago, Ill: AMA; 1998:104–10.
Angell M. Science on Trial: The Clash of Medical Evidence and the Law in the Breast Implant Case. London, New York: W.W. Norton and Company; 1997:205.
Cecil JS, Willging TE. Court-Appointed Experts: Defining the Role of Experts Appointed under Federal Rule of Evidence 706. Washington, DC: Federal Judicial Center; 1993.
Rasor DJ. Mandatory medical malpractice screening panels: a need to re-evaluate. Ohio St J Disp Resol. 1993;9:115–38.
Meadow W, Sunstein CS. Statistics, Not Experts. Chicago, Ill: John M. Olin Law and Economics Working Paper No. 109, (2D Series); 2000.
The Official ABMS Directory of Board-Certified Medical Specialists 2000, 32nd Ed. New Providence, NJ: Reed Elsevier, Inc.; 1999.
American Medical Association (AMA) (1995–2000) AMA Physician Select. URL http://www.americanmedicalassociation.org (1999). Accessed May 20, 1999.
United States Census Bureau. Census of Population and Housing Table: States and Counties by Urban/Rural Population, 1990, Summary Tape File 3B CD-Rom. Washington DC: U.S. Department of Commerce; 1995.
Peters PG. The quiet demise of deference to custom: malpractice law at the millennium. Wash Lee L Rev. 2000;57:163–205.
Caplan RA, Posner KL, Cheney FW. Effect of outcome on physician judgments of appropriateness of care. JAMA. 1991;265:1957–60.
Harvard Medical Practice Study Group. Patients, Doctors, and Lawyers: Medical Injury, Malpractice Litigation, and Patient Compensation in New York. Cambridge, Mass: Harvard University Press; 1990:52.
Colliver JA, Swartz MH. Assessing clinical performance with standardized patients. JAMA. 1997;278:790–1.
Peabody JW, Luck J, Glassman P, Dresselhaus TR, Lee M. Comparison of vignettes, standardized patients, and chart abstraction: a prospective validation study of 3 methods for measuring quality. JAMA. 2000;283:1715–22.
St. Paul Fire and Marine Insurance Co. Physicians and Surgeons Update: The St. Paul’s Annual Report to Policyholders. St. Paul, Minn: St. Paul Medical Services; 1998.
Danzon P. Medical Malpractice: Theory, Evidence, and Public Policy. Cambridge, Mass: Harvard University Press; 1985:31.
Federal Rules of Evidence. Rule 703.
Author information
Authors and Affiliations
Corresponding author
Additional information
The work of Dr. Hartz was supported in part by a grant from the Health Services and Resources Administration (5D32PE10195-02). The work of Mr. Lucas was supported by grants from the Health Services and Resources Administration (PD15 PE87007 and 5D32PE10195-02) and from the National Heart, Lung, and Blood Institute (2T35HL07485-21).
Rights and permissions
About this article
Cite this article
Hartz, A., Lucas, J., Cramm, T. et al. Physician surveys to assess customary care in medical malpractice cases. J GEN INTERN MED 17, 546–555 (2002). https://doi.org/10.1046/j.1525-1497.2002.10740.x
Issue Date:
DOI: https://doi.org/10.1046/j.1525-1497.2002.10740.x