The Experts below are selected from a list of 360 Experts worldwide ranked by ideXlab platform
Sanjay E Patra - One of the best experts on this subject based on the ideXlab platform.
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external ventricular drain placement accuracy and safety when done by midlevel practitioners
Neurosurgery, 2019Co-Authors: Nathaniel R Ellens, Luke D Fischer, Jason Meldau, Brett Schroeder, Sanjay E PatraAbstract:Background External ventricular drains (EVDs) measure intracranial pressure, divert cerebrospinal fluid, and allow for orthotropic administration of pharmacologic agents. Currently, Neurosurgeons and neurosurgery residents are the primary practitioners placing EVDs. Due to the urgency of neurosurgical pathologies and the lack of qualified residents at most hospitals, midlevel practitioner (MLP) placement of EVDs would be advantageous. Objective To assess the accuracy and complication rates of MLP and Neurosurgeon EVD placement. Methods This was a retrospective cohort of all patients with an EVD placed between January 2012 and September 2016 at a level 1 trauma center. We compared safety and accuracy of EVD placement between Neurosurgeons and MLPs. Results MLP first attempted EVD placement in 238 patients and senior Neurosurgeon first attempted EVD placement in 70 subjects. There was no significant difference between accuracy of placement within the ventricle (87.4% vs 90.0%, P = .5557), hemorrhage rate (5.9% vs 4.3%, P = .77), or infection rate (0.8% vs 1.4%, P = .5399) for placement attempted by an MLP compared with a Neurosurgeon, respectively. Conclusion MLPs perform EVD placement safely with no significant difference in accuracy of placement or complication rates compared with placement by senior Neurosurgeons. This may allow for earlier management of elevated intracranial pressure and access to care where previously unavailable; leading to improved patient outcomes.
Timothy R Smith - One of the best experts on this subject based on the ideXlab platform.
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international defensive medicine in neurosurgery comparison of canada south africa and the united states
World Neurosurgery, 2016Co-Authors: Sandra C Yan, Maher M Hulou, David J Cote, William B Gormley, James T Rutka, David Roytowski, Timothy R SmithAbstract:Objective Perception of medicolegal risk has been shown to influence defensive medicine behaviors. Canada, South Africa, and the United States have 3 vastly different health care and medicolegal systems. There has been no previous study comparing defensive medicine practices internationally. Methods An online survey was sent to 3672 Neurosurgeons across Canada, South Africa, and the United States. The survey included questions on the following domains: surgeon demographics, patient characteristics, physician practice type, surgeon liability profile, defensive behavior—including questions on the frequency of ordering additional imaging, laboratory tests, and consults—and perception of the liability environment. Responses were analyzed, and multivariate logistic regression was used to examine the correlation of medicolegal risk environment and defensive behavior. Results The response rate was 30.3% in the United States ( n = 1014), 36.5% in Canada ( n = 62), and 41.8% in South Africa ( n = 66). Canadian Neurosurgeons reported an average annual malpractice premium of $19,110 (standard deviation [SD] = $11,516), compared with $16,262 (SD = $7078) for South African respondents, $75,857 (SD = $50,775) for Neurosurgeons from low-risk U.S. states, and $128,181 (SD = $79,355) for those from high-risk U.S. states. Neurosurgeons from South Africa were 2.8 times more likely to engage in defensive behaviors compared with Canadian Neurosurgeons, while Neurosurgeons from low-risk U.S. states were 2.6 times more likely. Neurosurgeons from high-risk U.S. states were 4.5 times more likely to practice defensively compared with Canadian Neurosurgeons. Conclusions Neurosurgeons from the United States and South Africa are more likely to practice defensively than Neurosurgeons from Canada. Perception of medicolegal risk is correlated with reported neurosurgical defensive medicine within these countries.
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defensive medicine in neurosurgery the canadian experience
Journal of Neurosurgery, 2016Co-Authors: Timothy R Smith, Brian V Nahed, Maya A Babu, Maher M Hulou, Sandra C Yan, David J Cote, Sunit Das, William B Gormley, James T Rutka, Edward R LawsAbstract:OBJECT Recent studies have examined the impact of perceived medicolegal risk and compared how this perception impacts defensive practices within the US. To date, there have been no published data on the practice of defensive medicine among Neurosurgeons in Canada. METHODS An online survey containing 44 questions was sent to 170 Canadian Neurosurgeons and used to measure Canadian Neurosurgeons’ perception of liability risk and their practice of defensive medicine. The survey included questions on the following domains: surgeon demographics, patient characteristics, type of physician practice, surgeon liability profile, policy coverage, defensive behaviors, and perception of the liability environment. Survey responses were analyzed and summarized using counts and percentages. RESULTS A total of 75 Neurosurgeons completed the survey, achieving an overall response rate of 44.1%. Over one-third (36.5%) of Canadian Neurosurgeons paid less than $5000 for insurance annually. The majority (87%) of Canadian neurosu...
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neurosurgical defensive medicine in texas and illinois a tale of 2 states
World Neurosurgery, 2016Co-Authors: David J Cote, Aditya V Karhade, Alexandra M G Larsen, Joseph P Castlen, Timothy R SmithAbstract:Objective To compare the self-reported liability characteristics and defensive medicine practices of Neurosurgeons in Texas with Neurosurgeons in Illinois in an effort to describe the effect of medicolegal environment on defensive behavior. Methods An online survey was sent to 3344 members of the American Board of Neurological Surgery. Respondents were asked questions in 8 domains, and responses were compared between Illinois, the state with the highest reported average malpractice insurance premium, and Texas, a state with a relatively low average malpractice insurance premium. Results In Illinois, 85 of 146 (58.2%) Neurosurgeons surveyed responded to the survey. In Texas, 65 of 265 (24.5%) Neurosurgeons surveyed responded. In Illinois, Neurosurgeons were more likely to rate the overall burden of liability insurance premiums to be an extreme/major burden (odds ratio [OR] = 7.398, P $2 million in total coverage (OR = 9.814, P Conclusions Neurosurgeons in Illinois are more likely to believe that there is an ongoing medical liability crisis and more likely to practice defensively than Neurosurgeons in Texas.
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defensive medicine in neurosurgery does state level liability risk matter
Neurosurgery, 2015Co-Authors: Timothy R Smith, Ali Habib, Joshua M Rosenow, Brian V Nahed, Maya A Babu, George R Cybulski, Richard G Fessler, Hunt H Batjer, Robert F HearyAbstract:Background Defensive medicine is prevalent among US Neurosurgeons due to the high risk of malpractice claims. This study provides national estimates of US Neurosurgeons' defensive behaviors and perceptions. Objective To examine the relationship of defensive medicine-both "assurance" behaviors and "avoidance" behaviors-to the liability environment. Methods A 51-question online survey was sent to 3344 US Neurosurgeon members of the American Board of Neurological Surgeons (ABNS). The survey was anonymous and conducted over 6 weeks in the spring of 2011. The previously validated questionnaire contained questions on Neurosurgeon, patient, and practice characteristics; perceptions of the liability environment; and defensive-medicine behaviors. Bivariate and multivariate analyses examined the state liability risk environment as a predictor of a Neurosurgeon's likelihood of practicing defensive medicine. Results A total of 1026 Neurosurgeons completed the survey (31% response rate). Neurosurgeons' perceptions of their state's liability environment generally corresponded well to more objective measures of state-level liability risk because 83% of respondents correctly identified that they were practicing in a high-risk environment. When controlling for surgeon experience, income, high-risk patient load, liability history, and type of patient insurance, Neurosurgeons were 50% more likely to practice defensive medicine in high-risk states compared with low-risk-risk states (odds ratio: 1.5, P Conclusion Both avoidance and assurance behaviors are prevalent among US Neurosurgeons and are correlated with subjective and objective measures of state-level liability risk. Defensive medicine practices do not align with patient-centered care and may contribute to increased inefficiency in an already taxed health care system.
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malpractice liability and defensive medicine a national survey of Neurosurgeons
PLOS ONE, 2012Co-Authors: Brian V Nahed, Timothy R Smith, Maya A Babu, Robert F HearyAbstract:Background Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and Neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American Neurosurgeons’ perceptions of malpractice liability and defensive medicine practices. Methods A validated, 51-question online-survey was sent to 3344 practicing U.S. Neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of Neurosurgeons in academic and private practices. Results A total of 1028 surveys were completed (31% response rate) by Neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a “major or extreme” burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. Conclusions Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some Neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.
Maya A Babu - One of the best experts on this subject based on the ideXlab platform.
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maintenance of certification perceptions and attitudes of Neurosurgeons
Neurosurgery, 2018Co-Authors: Maya A Babu, Linda M Liau, Sander E Connolly, Fredric B MeyerAbstract:Assuring clinical competence throughout the career of a Neurosurgeon is of paramount importance for patient safety. We present the first comprehensive survey of all Neurosurgeons board certified through the American Board of Neurological Surgery (ABNS) to evaluate perceptions of Maintenance of Certification (MOC). We administered a validated, online, confidential survey to 4899 Neurosurgeons (2435 ABNS diplomates participating in MOC, 1440 diplomates certified prior to 1999 [time-unlimited certificates], and 1024 retired diplomates). We received 1449 responses overall (30% response rate). Our study found that most respondents believe that Neurosurgeons should be required to participate in continuing professional improvement following initial board certification (75%). Most believe that specialty boards, working in conjunction with specialty societies, should require diplomates to participate in programs meant to promote continuous professional development (73%). The majority of respondents (76%) believed that self-assessment tests constituted a meaningful professional development activity, in addition to periodic case log reviews (33%) or quality improvement projects (32.6%). A plurality of respondents (44%) do not feel that the MOC process as currently structured provides them with value. There were no differences between those who were "grandfathered" and those who actively participate in MOC and no differences between those in private practice versus those in academics. The ABNS is cognizant of diplomate concerns and is actively developing new MOC paradigms to ensure that the process achieves both the goals of meeting the public interest and assuring that the quality of American neurosurgery remains exemplary.
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recognized focused practice does sub specialty designation offer value to the Neurosurgeon
PLOS ONE, 2017Co-Authors: Maya A Babu, Linda M Liau, Fredric B MeyerAbstract:Vehicles for life-long assessment such as Maintenance of Certification tend to focus on generalist neurosurgical knowledge. However, as Neurosurgeons advance in their careers, they tend to narrow their practice and increase volumes in certain specific types of operations. Failing to test the type of procedures most relevant to the practitioner is a lost opportunity to improve the knowledge and practice of the individual Neurosurgeon. In this study, we assess the neurosurgical community's appetite for designations of board-recognized Recognized Focused Practice (RFP). We administered a validated, online, confidential survey to 4,899 Neurosurgeons (2,435 American Board of Neurological Surgery (ABNS) Diplomates participating in MOC, 1,440 Diplomates certified prior to 1999 (grandfathered), and 1,024 retired Diplomates). We received 1,449 responses overall (30% response rate). A plurality of respondents were in practice 11-15 years (18.5%), in private practice (40%) and participate in MOC (61%). 49% of respondents felt that a RFP designation would not be helpful. For the 30% who felt that RFP would be helpful, 61.3% felt that it would support recognition by their hospital or practice, it would motivate them to stay current on medical knowledge (53.4%), or it would help attract patients (46.4%;). The most popular suggestions for RFP were Spine (56.2%), Cerebrovascular (62.9%), Pediatrics (64.1%), and Functional/Stereotactic (52%). A plurality of Neurosurgeons (35.7%) felt that RFP should recognize Neurosurgeons with accredited and non-accredited fellowship experience and sub-specialty experience. Ultimately, Recognized Focused Practice may provide value to individual Neurosurgeons, but the neurosurgical community shows tepid interest for pursuing this designation.
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the aging Neurosurgeon when is enough enough attitudes toward ceasing practice and testing in late career
Mayo Clinic Proceedings, 2017Co-Authors: Maya A Babu, Linda M Liau, Robert J Spinner, Fredric B MeyerAbstract:Abstract Objective To present the first wide-scale survey to assess perceptions of testing the aging Neurosurgeon. Patients and Methods This study included 4899 Neurosurgeons, 2435 American Board of Neurological Surgery Diplomates participating in Maintenance of Certification (MOC), 1440 Diplomates certified before 1999 (grandfathered), and 1024 retired Diplomates. We developed an online confidential survey conducted from March 1, 2016, to May 31, 2016. We received 1449 responses overall (30% response rate). Results Most respondents (938; 65%) were aged 50 years and older. Overall, most respondents (718; 50%) believe that the aging Neurosurgeon (65 years and older) should undergo additional testing, including cognitive assessment or a review of cases, in addition to a standard (MOC) examination. Nine hundred fifty-six (67%) respondents believed that there should be no absolute age cutoff at which neurosurgical practice is forced to end. Six hundred six (42%) respondents believed that MOC should be tailored to accommodate the aging Neurosurgeon. Most respondents (766; 59%) believed that MOC should consist of a review individual case logs and patient outcomes for the aging Neurosurgeon. Conclusion Appropriately assessing the aging Neurosurgeon is important to protect patient safety and also maximize the capacity of an aging neurosurgical workforce. This first of its kind survey of Neurosurgeon diplomates of the American Board of Neurological Surgery provides important information as to what mechanisms can be created to fairly evaluate aging Neurosurgeons. Although this is a study of Neurosurgeons, the implications of these findings are widely applicable across specialties, and additional research on testing for aging and competency is needed across specialties.
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Does the Open Payments Database Provide Sunshine on Neurosurgery
Neurosurgery, 2016Co-Authors: Maya A Babu, Robert F Heary, Brian V NahedAbstract:BACKGROUND: The Open Payments Database (OPD) was launched by the Centers for Medicare & Medicaid Services in 2014. Through this online searchable database, the public can explore physician-industry interactions. To date, there is no published literature on the accuracy of the database for Neurosurgeons or any physician specialty. OBJECTIVE: To study the accuracy of published records and scope of industry-Neurosurgeon relationships between Neurosurgeons and industry within the OPD. METHODS: We searched 4.3 million records in 2013 and 11.41 million records in 2014 in the OPD for board-certified Neurosurgeons verified by the American Board of Neurological Surgery. Delimit software was used to condense these data, Microsoft Access for database queries, and STATA to perform descriptive analyses. RESULTS: Of the 3240 Neurosurgeons in the OPD in 2013, 2020 were identified correctly as Neurosurgeons within the database (62%). Of the 3593 Neurosurgeons in the OPD in 2014, 2433 were identified correctly as Neurosurgeons (68%). Within the OPD in 2013, there were 72 066 attributed records for Neurosurgeons; within the 2014 OPD, there were 160 563 attributed records for Neurosurgeons. Total payments to Neurosurgeons in 2013 (for the 9 months published in OPD): $61 802 659.37; in 2014: $117 127 824.00. CONCLUSION: The OPD details physician interactions with industry and has multiple inaccuracies. Publicly availing inaccurate information through a searchable governmental website that can be accessed by patients and journalists alike has the potential to tarnish individual Neurosurgeons and undermine professional credibility. ABBREVIATIONS: CMS, Centers for Medicare & Medicaid ServicesOPD, Open Payments Database.
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defensive medicine in neurosurgery the canadian experience
Journal of Neurosurgery, 2016Co-Authors: Timothy R Smith, Brian V Nahed, Maya A Babu, Maher M Hulou, Sandra C Yan, David J Cote, Sunit Das, William B Gormley, James T Rutka, Edward R LawsAbstract:OBJECT Recent studies have examined the impact of perceived medicolegal risk and compared how this perception impacts defensive practices within the US. To date, there have been no published data on the practice of defensive medicine among Neurosurgeons in Canada. METHODS An online survey containing 44 questions was sent to 170 Canadian Neurosurgeons and used to measure Canadian Neurosurgeons’ perception of liability risk and their practice of defensive medicine. The survey included questions on the following domains: surgeon demographics, patient characteristics, type of physician practice, surgeon liability profile, policy coverage, defensive behaviors, and perception of the liability environment. Survey responses were analyzed and summarized using counts and percentages. RESULTS A total of 75 Neurosurgeons completed the survey, achieving an overall response rate of 44.1%. Over one-third (36.5%) of Canadian Neurosurgeons paid less than $5000 for insurance annually. The majority (87%) of Canadian neurosu...
Brian V Nahed - One of the best experts on this subject based on the ideXlab platform.
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Does the Open Payments Database Provide Sunshine on Neurosurgery
Neurosurgery, 2016Co-Authors: Maya A Babu, Robert F Heary, Brian V NahedAbstract:BACKGROUND: The Open Payments Database (OPD) was launched by the Centers for Medicare & Medicaid Services in 2014. Through this online searchable database, the public can explore physician-industry interactions. To date, there is no published literature on the accuracy of the database for Neurosurgeons or any physician specialty. OBJECTIVE: To study the accuracy of published records and scope of industry-Neurosurgeon relationships between Neurosurgeons and industry within the OPD. METHODS: We searched 4.3 million records in 2013 and 11.41 million records in 2014 in the OPD for board-certified Neurosurgeons verified by the American Board of Neurological Surgery. Delimit software was used to condense these data, Microsoft Access for database queries, and STATA to perform descriptive analyses. RESULTS: Of the 3240 Neurosurgeons in the OPD in 2013, 2020 were identified correctly as Neurosurgeons within the database (62%). Of the 3593 Neurosurgeons in the OPD in 2014, 2433 were identified correctly as Neurosurgeons (68%). Within the OPD in 2013, there were 72 066 attributed records for Neurosurgeons; within the 2014 OPD, there were 160 563 attributed records for Neurosurgeons. Total payments to Neurosurgeons in 2013 (for the 9 months published in OPD): $61 802 659.37; in 2014: $117 127 824.00. CONCLUSION: The OPD details physician interactions with industry and has multiple inaccuracies. Publicly availing inaccurate information through a searchable governmental website that can be accessed by patients and journalists alike has the potential to tarnish individual Neurosurgeons and undermine professional credibility. ABBREVIATIONS: CMS, Centers for Medicare & Medicaid ServicesOPD, Open Payments Database.
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defensive medicine in neurosurgery the canadian experience
Journal of Neurosurgery, 2016Co-Authors: Timothy R Smith, Brian V Nahed, Maya A Babu, Maher M Hulou, Sandra C Yan, David J Cote, Sunit Das, William B Gormley, James T Rutka, Edward R LawsAbstract:OBJECT Recent studies have examined the impact of perceived medicolegal risk and compared how this perception impacts defensive practices within the US. To date, there have been no published data on the practice of defensive medicine among Neurosurgeons in Canada. METHODS An online survey containing 44 questions was sent to 170 Canadian Neurosurgeons and used to measure Canadian Neurosurgeons’ perception of liability risk and their practice of defensive medicine. The survey included questions on the following domains: surgeon demographics, patient characteristics, type of physician practice, surgeon liability profile, policy coverage, defensive behaviors, and perception of the liability environment. Survey responses were analyzed and summarized using counts and percentages. RESULTS A total of 75 Neurosurgeons completed the survey, achieving an overall response rate of 44.1%. Over one-third (36.5%) of Canadian Neurosurgeons paid less than $5000 for insurance annually. The majority (87%) of Canadian neurosu...
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defensive medicine in neurosurgery does state level liability risk matter
Neurosurgery, 2015Co-Authors: Timothy R Smith, Ali Habib, Joshua M Rosenow, Brian V Nahed, Maya A Babu, George R Cybulski, Richard G Fessler, Hunt H Batjer, Robert F HearyAbstract:Background Defensive medicine is prevalent among US Neurosurgeons due to the high risk of malpractice claims. This study provides national estimates of US Neurosurgeons' defensive behaviors and perceptions. Objective To examine the relationship of defensive medicine-both "assurance" behaviors and "avoidance" behaviors-to the liability environment. Methods A 51-question online survey was sent to 3344 US Neurosurgeon members of the American Board of Neurological Surgeons (ABNS). The survey was anonymous and conducted over 6 weeks in the spring of 2011. The previously validated questionnaire contained questions on Neurosurgeon, patient, and practice characteristics; perceptions of the liability environment; and defensive-medicine behaviors. Bivariate and multivariate analyses examined the state liability risk environment as a predictor of a Neurosurgeon's likelihood of practicing defensive medicine. Results A total of 1026 Neurosurgeons completed the survey (31% response rate). Neurosurgeons' perceptions of their state's liability environment generally corresponded well to more objective measures of state-level liability risk because 83% of respondents correctly identified that they were practicing in a high-risk environment. When controlling for surgeon experience, income, high-risk patient load, liability history, and type of patient insurance, Neurosurgeons were 50% more likely to practice defensive medicine in high-risk states compared with low-risk-risk states (odds ratio: 1.5, P Conclusion Both avoidance and assurance behaviors are prevalent among US Neurosurgeons and are correlated with subjective and objective measures of state-level liability risk. Defensive medicine practices do not align with patient-centered care and may contribute to increased inefficiency in an already taxed health care system.
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Dabigatran, intracranial hemorrhage, and the Neurosurgeon
Neurosurgical focus, 2013Co-Authors: Ahmed J. Awad, Brian V Nahed, Brian P. Walcott, Christopher J. Stapleton, Vijay Yanamadala, Jean-valery CoumansAbstract:Dabigatran etexilate (Pradaxa) is a novel oral anticoagulant that has gained FDA approval for the prevention of ischemic stroke and systemic embolism in patients with nonvalvular atrial fibrillation. In randomized trials, the incidence of hemorrhagic events has been demonstrated to be lower in patients treated with dabigatran compared with the traditional anticoagulant warfarin. However, dabigatran does not have reliable laboratory tests to measure levels of anticoagulation and there is no pharmacological antidote. These drawbacks are challenging in the setting of intracerebral hemorrhage. In this article, the authors provide background information on dabigatran, review the existing anecdotal experiences with treating intracerebral hemorrhage related to dabigatran therapy, present a case study of intracranial hemorrhage in a patient being treated with dabigatran, and suggest clinical management strategies. The development of reversal agents is urgently needed given the growing number of patients treated with this medication.
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malpractice liability and defensive medicine a national survey of Neurosurgeons
PLOS ONE, 2012Co-Authors: Brian V Nahed, Timothy R Smith, Maya A Babu, Robert F HearyAbstract:Background Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and Neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American Neurosurgeons’ perceptions of malpractice liability and defensive medicine practices. Methods A validated, 51-question online-survey was sent to 3344 practicing U.S. Neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of Neurosurgeons in academic and private practices. Results A total of 1028 surveys were completed (31% response rate) by Neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a “major or extreme” burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. Conclusions Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some Neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.
Jason S. Hauptman - One of the best experts on this subject based on the ideXlab platform.
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medicolegal issues in abusive head trauma for the pediatric Neurosurgeon
Neurosurgical Focus, 2020Co-Authors: David I Bass, Samuel R Browd, Richard G. Ellenbogen, Jason S. Hauptman, Amy S LeeAbstract:The purpose of this article is to serve as a rational guide for the pediatric Neurosurgeon in navigating common medicolegal issues that arise in the management of abusive head trauma (AHT). Many of these issues may be unfamiliar or unpleasant to surgeons focused on addressing disease. The authors begin with a brief history on the origins of the diagnosis of AHT and the controversy surrounding it, highlighting some of the facets of the diagnosis that make it particularly unique in pediatric neurosurgery. They then review some special medical considerations in these patients through the perspective of the Neurosurgeon and provide several examples as illustration. The authors discuss how to appropriately document these cases in the medical record for expected legal review, and last, they provide an overview of the legal process through which the Neurosurgeon may be called to provide testimony.
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Issues of consent and assent in pediatric neurosurgery
Child's Nervous System, 2020Co-Authors: Rajeev D. Sen, Samuel R Browd, Amy Lee, Richard G. Ellenbogen, Jason S. HauptmanAbstract:Background Consent and assent are important concepts to understand in the care of pediatric neurosurgery patients. Recently it has been recommended that although pediatric patients generally do not have the legal capacity to make medical decisions, they be encouraged to be involved in their own care. Given the paucity of information on this topic in the neurosurgery community, the objective is to provide pediatric Neurosurgeons with recommendations on how to involve their patients in medical decision-making. Methods We review the essential elements and current guidelines of consent and assent for pediatric patients using illustrative neurosurgical case vignettes. Results The pediatric population ranges widely in cognitive and psychological development making the process of consent and assent quite complex. The role of the child or adolescent in medical decision-making, issues associated with obtaining assent or dissent, and informed refusal of treatment are considered. Conclusion The process of obtaining consent and assent represents a critical yet often overlooked aspect to care of pediatric neurosurgical patients. The pediatric Neurosurgeon must be able to distill immensely complex and high-risk procedures into simple, understandable terms. Furthermore, they must recognize when the child’s dissent or refusal to treatment is acceptable. In general, allowing children to be involved in their neurosurgical care is empowering and gives them both identity and agency, which is the vital first step to a successful neurosurgical intervention.