Medical-legal concerns among Canadian anaesthetists

This paper reports the results of a national survey of anaesthetists which was undertaken to determine the effect of liability concerns on the practice of anaesthesia. Four hundred seventy-six anaesthetists from four regions (East, Quebec, Ontario and the West) (overall usable response rate of 73.3 per cent) responded to a series of questions on sources of liability information, changes in practice patterns over the past five years, changes in style of practice and attitudes towards the physician— patient relationship and to medical-legal concerns. The major findings were that the respondents rated liability concerns as the first or second most important reason for making major changes in their practice. Some of the changes in practice were related to increased use of monitoring, more time spent with patients discussing the risks of anaesthesia and increased documentation. On the negative side, respondents had decreased the administration of obstetrical and paediatric anaesthesia and were ordering more laboratory tests and x-rays. The majority of respondents agreed that the physician— patient relationship has suffered in recent years and physicians who had been in practice for longer periods of time were more likely to be dissatisfied and to consider leaving the field of medicine. However, the survey could not show a cause-and-effect relationship between claimed practice changes and fear of litigation.