Effect of the threat of malpractice on the decision to hospitalize a suicidal patient

This study investigated the effect of a threat of malpractice on the decision to hospitalize a hypothetical suicidal outpatient, as well as other treatment variables, via a litigious and nonlitigious vignette condition administered in a questionnaire format to doctoral students in clinical psychology at a professional graduate school in the San Francisco Bay Area. Questionnaires were randomly distributed to 327 of these clinical psychology students' mailboxes, yielding a usable response rate of 42.5% or 139 respondents. The primary purpose of the present study was to determine whether doctoral students in clinical psychology would recommend a higher rate of hospitalization and longer length of hospital stay for litigious suicidal outpatients than for nonlitigious suicidal outpatients, suggesting a defensive standard of care for these patients. A secondary purpose was to determine whether other patterns of defensive practice would be revealed in the subjects' responses to questions about psychological testing, lab testing, consultations, information needed, formal assessment of suicidality, continuity of care, probability of patient suicide, and probability that a malpractice suit would be initiated by the hypothetical patient.;Results from the primary analyses indicated that there were no significant differences between the two conditions in rate of patient hospitalization or length of hospital stay. Results from the secondary analyses yielded two significant findings suggesting that litigiousness had an impact on the subjects but in an opposite direction than that predicted. In the first instance, it was predicted that subjects in the litigious group would list more information as needed from the patient as a defensive response to the litigation threat. This did not happen. These subjects demonstrated significantly less interest in further information than those in the nonlitigious group. In the second case, subjects in the litigious group requested a consultation with an internist significantly less often than subjects in the nonlitigious group. Both of these findings suggest that a subtle form of defensive practice may operate under the condition of litigiousness, and that clinical curiosity may decrease due to legal concerns among the subjects sampled. Additionally, there was a tendency for subjects in the litigious group to estimate a higher mean probability of a malpractice suit than those in the nonlitigious group, suggesting that legal concerns were of greater concern to these subjects.;Post hoc analyses of questionnaire items by training in professional malpractice/liability and defensive medicine or suicide assessment showed that the standard of care provided the patient varied by whether subjects had received training in either of these areas.