Defensive medicine and obstetrics

Objective.

—To test the hypothesis that physicians with greater malpractice claims exposure, either through personal experience or in their practice environment, will use more prenatal resources and have a higher cesarean delivery rate than physicians with lesser claims exposure.

Design.

—Retrospective cohort study using county malpractice defendant rate data from the Washington State Physicians Insurance and Exchange Association and prenatal care, delivery method, and self-reported obstetric suit experience data from the Content of Obstetrical Care Study database.

Setting.

—Washington State obstetric practices.

Participants.

—Stratified random samples of obstetrician-gynecologists and family physicians.

Main Outcome Measures.

—The rates of obstetric ultrasound use, referral and consultation, prenatal care resource use, and cesarean delivery.

Results.

—After controlling for patient, physician, and sociodemographic characteristics, we found no difference in prenatal resource use or cesarean delivery rate for low-risk patients between physicians with more and less exposure to malpractice claims.

Conclusions.

—This study does not support an association between the malpractice experience or exposure of individual physicians and an increase in the use of prenatal resources or cesarean deliveries for the care of low-risk obstetric patients. (JAMA. 1995;274:1606-1610)