Effect of Increasing Malpractice Insurance Cost and Subsequent Practice of Defensive Medicine on Out-of-Hospital Birth Rates in the United States.

BACKGROUND: Across the United States, the burden of malpractice litigation has influenced obstetricians and obstetric institutions to avoid high-risk patients, favor cesarean delivery, and decrease availability of trial of labor after cesarean. Recently, the United States has experienced an increase in out-of-hospital (OOH) births. OBJECTIVE: The main purpose of this article is to investigate the association between malpractice insurance premium (MIP) and OOH births in the United States from 2000 to 2014. STUDY DESIGN: We analyzed changes in OOH birth rates and MIP from 2000 to 2014 using birth data from the National Vital Statistics System and Medical Liability Monitor's annual survey, respectively. The change in OOH birth rates was then compared with the change in MIP. RESULTS: Between 2000 and 2014, there has been approximately 60% increase in MIP from national average of $40,949 to $65,210 (p < 0.05). OOH births increased 57% from 39,398 births to 59,674 births (p < 0.05). There was a significant positive correlation between increase in MIP and increase in OOH births (p < 0.05, R 2 = 0.14). CONCLUSION: MIP and OOH birth rates have a significantly associated increase from 2000 to 2014. Given that malpractice climate affects other aspects of obstetric practice, we cautiously propose that increasing MIP may be associated with an increase in OOH births.

"A Word can become a Seed": A Lesson Learned about Cultural Humility.

Culturally competent cancer care approaches are necessary to effectively engage ethnic and racial minorities. This reflection shares personal insights on this subject gained throughout my journey from a young immigrant to a medical and public health student in the USA. The death of a friend prompted me to explore what I had deemed as my family's taboo subjects: discussing illness, cancer, and death in the family. However, I eventually realized that it was I who perceived it as taboo subjects. When I inquired earnestly about their health beliefs and values and asked questions in a way that respected those beliefs and values, my family was quite willing to talk about these uncomfortable topics. Subsequent encounters with minority patients and the process of synthesizing this reflection helped me recognize that the way I successfully addressed what I had erroneously assumed to be taboo subjects embodied the idea of cultural humility and can also be applied to issues with other minority patients and families. This recognition will not only make me a better physician but also allow me to become a strong advocate of cultural humility, especially in cancer care and education.