Medico-Legal Risk in Maternal Serum Screening: Perspective of Ontario Health Care Providers

Abstract

Objective: to determine whether Ontario health care providers perceived a change in their medico-legal risk since the introduction of maternal serum screening (MSS), a province-wide genetic screening programme, in July 1993.Design: cross-sectional self-reported survey.Setting: Ontario.Participants: all Ontario obstetricians (n=565), all licensed midwives (n=62) and a random sample of 2,000 family physicians were surveyed. Only those currently providing antenatal care or attending births were eligible. The response rate was 91 percent for family physicians, 76 percent for obstetricians and 78 percent for midwives.Results: thirty-three percent of family physicians and 40 percent of obstetricians perceived that their medico-legal risk had been affected by the introduction of MSS. The vast majority indicated in written comments that they felt their risk had increased. There were significant differences (p<0.001) between the provider groups, with proportionately fewer midwives feeling that their liability had been affected. The most frequent concerns expressed included failure to maintain a new standard of care, lack of informed consent due to the inherent complexity of the test, lack of sensitivity I specificity of the test and related consequences, and the expectation of the provider to ensure a perfect pregnancy outcome.Conclusions: most of the concerns revolved around interaction with patients, and highlight die importance of clear, effective communication about complex issues. As our technology advances, we are likely to see more genetic screening tests. The concerns expressed about MSS may be applicable to such tests in the future. It will be crucial for those providing the tests to be well educated in the complexity of issues involved.