Malpractice, defensive medicine, and obstetric behavior.
Malpractice, defensive medicine, and obstetric behavior.
复制标题
医疗事故、防御医学和产科行为。
DOI：
10.1097/00005650-199702000-00007
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发表时间：
1997
期刊：
影响因子：
3
通讯作者：
Wojtowycz,MA
中科院分区：
文献类型：
--
作者：
Tussing,AD;Wojtowycz,MA
目的。作者检查了纽约州纽约市以外的 58,441 例产科分娩，以测试产科中防御医学的存在。方法。数据由纽约州卫生部合并的生命统计数据和出院记录以及其他合并变量组成。医生对医疗事故的恐惧通过县 1975 年至 1986 年累积的产科医疗事故诉讼来体现。使用了广义概率分析。结果。医疗事故暴露对电子胎儿监护仪 (EFM)（一种主要诊断工具）的使用略有影响。研究表明，EFM 的使用会影响胎儿窘迫的诊断；对医疗事故的恐惧直接或通过 EFM 影响这一诊断。胎儿窘迫的诊断显着影响剖腹产（c-section）分娩方式的选择；因此，对医疗事故的恐惧会直接影响剖腹产的选择，也会影响胎儿窘迫的诊断。未能通过诊断程序和诊断纳入间接影响将导致低估医疗事故恐惧的影响。在数据集中 27.6% 的总体剖腹产率中，对不当行为的恐惧估计占 6.6 个百分点，其中 4.4 个百分点反映了直接影响，其余 2.2 个百分点反映了不当行为暴露对 EFM 的使用以及直接和间接胎儿窘迫诊断的影响。结论。结果似乎证实了产科中防御医学的存在。这是理想的还是不良的效果仍然不明确，但代价高昂。
Objectives.The authors examine 58,441 obstetric deliveries in New York State outside New York City to test for the existence of defensive medicine in obstetrics.Methods.The data consist of merged vital statistics and hospital discharge records from the New York State Department of Health, together with other merged variables. Physician fear of malpractice is proxied by cumulative obstetric malpractice suits by county for 1975 through 1986. A generalized probit analysis is used.Results.Malpractice exposure is shown to influence slightly the use of the electronic fetal monitor (EFM), a major diagnostic tool. Use of the EFM is shown to influence the diagnosis of fetal distress; fear of malpractice influences this diagnosis both directly and through the EFM. The diagnosis of fetal distress significantly affects the choice of cesarean section (c-section) as a method of delivery; hence, fear of malpractice influences the choice of a c-section both directly and through the diagnosis of fetal distress. Failure to include indirect effects via diagnostic procedures and diagnosis would result in an underestimate of the effect of fear of malpractice. Of an overall c-section rate of 27.6% in the data set, fear of malpractice accounts for an estimated 6.6 percentage points, of which 4.4 percentage points reflect a direct effect, and the remaining 2.2 percentage points reflect the effect of malpractice exposure on the use of the EFM and, directly and indirectly, the diagnosis of fetal distress.Conclusions.The results appear to confirm the existence of defensive medicine in obstetrics. Whether this is a desirable or undesirable effect remains ambiguous, but it is costly.