Defensive Medicine among Obstetricians and Gynecologists in Tertiary Hospitals

Abstract

ObjectiveTo describe the daily work practice under the threat of defensive medicine among obstetricians and gynecologists.Study DesignA prospective cross-sectional survey of obstetricians and gynecologists working at tertiary medical centers in Israel.ResultsAmong the 117 obstetricians and gynecologists who participated in the survey, representing 10% of the obstetricians and gynecologists registered by the Israel Medical Association, 113 (97%) felt that their daily work practice is influenced by concern about being sued for medical negligence and not only by genuine medical considerations. As a result, 102 (87%) physicians are more likely to offer the cesarean section option, even in the absence of a clear medical indication, 70 (60%) follow court rulings concerning medical practices, and 85 (73%) physicians mentioned that discussions about medical negligence court rulings are included in their departments' meetings.ConclusionsDefensive medicine is a well-embedded phenomenon affecting the medical decision process of obstetricians and gynecologists.

Defensive medicine in Italy a nationwide survey

“…In line with previous national and international studies, our physicians perceived the possibility of malpractice litigation as the major driver of DM practices [2,4,5,7,8,10,12,13,24]. A recurring theme in our study is that DM exists because physicians have a fear of being sued for malpractice and related issues.…”

“…In our study, we observed a 58.78% prevalence of practising DM, which is lower than reported in other studies [2,4,8,9,10,13]. This was probably due to our sample composition, which included a significant portion of physicians working in less risky specialities [7].…”

“…This probably means that the actual level of guideline implementation in the National Healthcare System is still suboptimal, or at least not effective enough to avoid DM. In fact, guidelines and related methods like clinical pathways still represent a generalisation of empirical evidence that may not always be applicable to individual patients and/or adopted by legislators [8,10]. These data must be taken as a lesson to learn for the future development of clinical guidelines and clinical pathways [9,22,29].…”

“…In the United States, 93% of physicians reported practising DM in a hospital, and 78% of hospital doctors in the United Kingdom and 60% in Israel practised DM in a hospital [2,4,7]. The percentage of doctors practising DM is higher for some specialties, including, obstetrics and gynaecology (97%), gastroenterology (94-98%), neurosurgery (75-83%), and orthopaedics and traumatology (96%) [5,8,9,10,11,12,13,14,15,16,17].…”

Litigations in Obstetric and Gynecological Practice: Can it be prevented? A Probability to Possibility

“…Defensive medicine is defined as ''medical actions, performed mainly in order to refrain from being sued, rather than actually aiding the patient'' [9]. The best example for this is the rates of cesarean sections are increasing these days.…”