Legal concerns trigger prostate-specific antigen testing

J Eval Clin Pract. 2009 Apr;15(2):390-2. doi: 10.1111/j.1365-2753.2008.01024.x.


Background: In the United States, lawsuits against physicians have had an impact on their behaviour, resulting in overdiagnosis and other forms of 'defensive medicine'. Does a similar situation exist in Switzerland? Using prostate-specific antigen (PSA) screening as an example, we surveyed Swiss physicians and assessed the extent to which liability fears influenced their recommendation for testing.

Methods: At a continuing medical education conference we distributed a pilot-tested questionnaire to 552 participants. Two hundred and fifty of them (45%) completed the questionnaire.

Results: Of the participants, 158 (68%) were general practitioners and 73 (32%) specialists in internal medicine. Seventy-five per cent of both groups recommend regular PSA screening to men older than age 50. Yet only 56% of the general physicians and 53% of the internists believe that PSA measurement is an effective screening method. A substantial proportion of the physicians - 41% of general practitioners and 43% of internists - reported that they sometimes or often recommend this test for legal reasons.

Conclusions: Defensive medicine is not a phenomenon particular to the USA, but is also observable in Switzerland. This result is surprising, given that in Switzerland and other European countries, a physician who does not recommend a test or treatment whose effectiveness is controversial need not fear litigation.

MeSH terms

  • Adult
  • Aged
  • Attitude of Health Personnel*
  • Defensive Medicine / legislation & jurisprudence*
  • Female
  • Humans
  • Male
  • Mass Screening / legislation & jurisprudence
  • Mass Screening / statistics & numerical data*
  • Middle Aged
  • Physicians / psychology
  • Prostate-Specific Antigen / analysis*
  • Surveys and Questionnaires
  • Switzerland


  • Prostate-Specific Antigen