A descriptive study of the effect of a disciplinary proceeding decision on medical practitioners' practice behaviour in the context of providing a hydrocortisone and lignocaine injection.

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  • Additional Information
    • Source:
      Publisher: Wolters Kluwer - Medknow Country of Publication: India NLM ID: 0404516 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 2737-5935 (Electronic) Linking ISSN: 00375675 NLM ISO Abbreviation: Singapore Med J Subsets: MEDLINE
    • Publication Information:
      Publication: July 2022- : [Mumbai] : Wolters Kluwer - Medknow
      Original Publication: Singapore, Singapore Medical Assn.
    • Subject Terms:
      Anesthetics, Local*/economics ; Anesthetics, Local*/therapeutic use ; Anti-Inflammatory Agents*/economics ; Anti-Inflammatory Agents*/therapeutic use ; Decision Making* ; Hydrocortisone*/economics ; Hydrocortisone*/therapeutic use ; Lidocaine*/economics ; Lidocaine*/therapeutic use ; Medical Errors*/economics ; Medical Errors*/psychology ; Practice Patterns, Physicians'*/economics; Physicians/*economics ; Physicians/*psychology; Drug Combinations ; Employee Discipline/economics ; Humans ; Physician-Patient Relations ; Physicians, Family ; Singapore ; Societies, Medical ; Surveys and Questionnaires
    • Abstract:
      Introduction: We conducted a descriptive study to evaluate any changes in practice behaviour regarding the provision of hydrocortisone and lignocaine (H&L) injections among doctors and how an H&L injection is priced following a disciplinary proceeding decision. A doctor had been fined SGD 100,000 for failing to obtain informed consent before an H&L injection.
      Methods: We performed a survey shortly after the disciplinary decision to ascertain: (a) the category of the respondent; (b) whether the respondent provided H&L injections and how much he charged before the decision; and (c) after the decision. All members of the Singapore Medical Association and College of Family Physicians Singapore are doctors and were invited to participate.
      Results: 1,927 doctors responded to the survey. Prior to the decision, 804 doctors did not perform H&L injections; this increased by 20.4% to 968 after the decision. The number of doctors who gave H&L injections decreased by 164 (14.6%), from the previous 1,123. Pre-decision, doctors who determined their own price for H&L injections charged a median pricing ≤ SGD 100. Post-decision, the median charge rose to > SGD 100 to SGD 200. At higher price bands, the number of doctors who charged > SGD 1,000 increased eight-fold, from eight to 65.
      Conclusion: The study demonstrated how a disciplinary decision can affect practice behaviour, and specifically how doctors may choose to not offer a service, an example of defensive medicine through avoidance behaviour. It also showed how prices for a service can rise following such a decision, which demonstrates the concept of negative general deterrence in sentencing.
      (Copyright: © Singapore Medical Association.)
    • References:
      JAMA. 2005 Jun 1;293(21):2609-17. (PMID: 15928282)
      World J Gastroenterol. 2006 Dec 21;12(47):7671-5. (PMID: 17171798)
      Health Aff (Millwood). 2010 Sep;29(9):1569-77. (PMID: 20820010)
    • Contributed Indexing:
      Keywords: Singapore; defensive medicine; deterrence; informed consent; practice behaviour
    • Accession Number:
      0 (Anesthetics, Local)
      0 (Anti-Inflammatory Agents)
      0 (Drug Combinations)
      98PI200987 (Lidocaine)
      WI4X0X7BPJ (Hydrocortisone)
    • Publication Date:
      Date Created: 20190801 Date Completed: 20210826 Latest Revision: 20210826
    • Publication Date:
      20231215
    • Accession Number:
      PMC7926588
    • Accession Number:
      10.11622/smedj.2019086
    • Accession Number:
      31363785