The Ecology of Defensive Medicine and Malpractice Litigation

PLoS One. 2016 Mar 16;11(3):e0150523. doi: 10.1371/journal.pone.0150523. eCollection 2016.

Abstract

Using an evolutionary game, we show that patients and physicians can interact with predator-prey relationships. Litigious patients who seek compensation are the 'predators' and physicians are their 'prey'. Physicians can adapt to the risk of being sued by performing defensive medicine. We find that improvements in clinical safety can increase the share of litigious patients and leave unchanged the share of physicians who perform defensive medicine. This paradoxical result is consistent with increasing trends in malpractice claims in spite of safety improvements, observed for example in empirical studies on anesthesiologists. Perfect cooperation with neither defensive nor litigious behaviors can be the Pareto-optimal solution when it is not a Nash equilibrium, so maximizing social welfare may require government intervention.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Defensive Medicine*
  • Game Theory
  • Humans
  • Malpractice / legislation & jurisprudence*
  • Patient Safety
  • Physicians

Grants and funding

The research of A. Antoci and P. Russu was financed by Regione Autonoma della Sardegna (L.R. 7/2007) under the project ‘Capitale sociale e divari economici regionali’. The research of A. Fiori Maccioni was financed by P.O.R. FSE Sardegna 2007/13 under the project ‘Risk Management System per aziende sanitarie’, held at the University of Sassari with the logistical support of Prossima Isola. The authors declare that the funding sources had no involvment in the research and have no conflicts of interest.