Clinical guidelines, defensive medicine, and the physician between the two

Toker, Alper; Shvarts, Shifra; Perry, Zvi H.; Doron, Yariv; Reuveni, Haim

doi:10.1016/j.amjoto.2004.02.002

Cited by 33 publications

(18 citation statements)

References 14 publications

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“…Defensive medicine is defined as a doctor’s deviation from their usual behavior or that considered good practice, to reduce or prevent complaints or criticism by patients or their families [6]. The United States Congress expand this definition to include the action of ordering tests, procedures and visits, or avoidance of high risk patients or procedures with the primary (but not sole) aim, of reducing mal-practice liability [7].…”

Section: Introductionmentioning

confidence: 99%

The practice of defensive medicine among hospital doctors in the United Kingdom

et al. 2013

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BackgroundDefensive medicine is defined as a doctor’s deviation from standard practice to reduce or prevent complaints or criticism. The objectives of this study were to assess the prevalence of the practice of defensive medicine in the UK among hospital doctors and the factors affecting it.MethodsA quantitative study was designed, with a detailed seventeen point questionnaire. Defensive medicine practice was assessed and tested against four factors age, gender, specialty and grade. Three hundred hospital doctors from three UK hospitals received the questionnaire.ResultsTwo hundred and four (68%) out of 300 hospital doctors responded to the survey. Seventy eight percent reported practicing one form or another of defensive medicine. Ordering unnecessary tests is the commonest form of defensive medicine reported by 59% of the respondents. This is followed by unnecessary referral to other specialties (55%). While only 9% of the sampled doctors would refuse to treat high risk patients, double this number would avoid high risks procedures all together (21%). A linear regression module has shown that only senior grade was associated with less practice of defensive medicine.ConclusionDefensive medical practice is common among the doctors who responded to the survey. Senior grade is associated with less practice of defensive medicine.

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Section: Introductionmentioning

confidence: 99%

The practice of defensive medicine among hospital doctors in the United Kingdom

et al. 2013

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“…In Israel data about defensive medicine is lacking. Only small studies issued this phenomenon and none of them was related to the extent of it [2], [6], [7]. Defensive medicine prevalence and characteristics remain controversial [8], [9] and to date no nationwide survey has been done to evaluate this phenomenon.…”

Section: Introductionmentioning

confidence: 99%

Defensive Medicine in Israel – A Nationwide Survey

et al. 2012

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BackgroundDefensive medicine is the practice of diagnostic or therapeutic measures conducted primarily as a safeguard against possible malpractice liability. We studied the extent, reasons, and characteristics of defensive medicine in the Israeli health care system.Methods and FindingsCross-sectional study performed in the Israeli health care system between April and July 2008 in a sample (7%) of board certified physicians from eight medical disciplines (internal medicine, pediatrics, general surgery, family medicine, obstetrics and gynecology, orthopedic surgery, cardiology, and neurosurgery). A total of 889 physicians (7% of all Israeli board certified specialists) completed the survey. The majority [60%, (95%CI 0·57–0·63)] reported practicing defensive medicine; 40% (95%CI 0·37–0·43) consider every patient as a potential threat for a medical lawsuit; 25% (95%CI 0·22–0·28) have previously been sued at least once during their career. Independent predictors for practicing defensive medicine were surgical specialty [OR = 1.6 (95%CI 1·2–2·2), p = 0·0004], not performing a fellowship abroad [OR = 1·5 (95%CI 1·1–2), p = 0·027], and previous exposure to lawsuits [OR = 2·4 (95%CI 1·7–3·4), p<0·0001]. Independent predictors for the risk of being sued during a physician's career were male gender [OR = 1·6 (95%CI 1·1–2·2), p = 0·012] and surgery specialty [OR = 3·2 (95%CI 2·4–4·3), p<0·0001] (general surgery, obstetrics and gynecology, orthopedic surgery, and neurosurgery).ConclusionsDefensive medicine is very prevalent in daily physician practice in all medical disciplines. It exposes patients to complications due to unnecessary tests and procedures, affects quality of care and costs, and undermines doctor-patient relationships. Further studies are needed to understand how to minimize defensive medicine resulting from an increased malpractice liability market.

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“…During the period after the intervention compared to the period before the intervention, a higher incidence of low perception of the quality of healthcare among the academic population was noticed, while the population outside academic institutions frequently showed low total scores for economic awareness. As a likely solution to cope with this important real-world cost driver, some authors recommended early prevention by the inclusion of the basics of health economics into undergraduate medical curricula (26). To the best of our knowledge, however, this is still not the case in most medical schools across the world.…”

Section: Discussionmentioning

confidence: 99%