Defensive Medicine Among Plastic and Aesthetic Surgeons in Israel

Silberstein, Eldad; Shir-Az, Ofir; Reuveni, Haim; Krieger, Yuval; Shoham, Yaron; Silberstein, Tali; Bogdanov-Berezovsky, Alexander

doi:10.1093/asj/sjw094

Cited by 11 publications

(8 citation statements)

References 14 publications

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“…as evidence of conscious practice of defensive medicine, as previous studies have done. 17 However, reporting specific behaviours in different scenarios is not necessarily conscious or unconscious behaviour. We aimed to ascertain conscious versus unconscious behaviour by calculating the correlation between the answer to the previous question and selfreports of defensive practice behaviours in the four clinical scenarios.…”

Section: Discussionmentioning

confidence: 99%

Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists

et al. 2017

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ObjectivePsychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists and to understand whether awareness of DP correlated with defensive behaviours.MethodsA questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims.ResultsForty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved in malpractice claims, while 132 (62.1%) participants admitted to practising DP. Residents acknowledged the practice of DP more than did senior psychiatrists (p=0.038).Awareness of DP correlated with unnecessary hospitalisation of suicidal patients, increased unnecessary follow-up visits and prescribing smaller drug dosages than required for pregnant women and elderly patients.ConclusionsThis study provides evidence that DP is well established in the routine clinical daily practice of psychiatrists. Further studies are needed to reveal whether DP effectively protects psychiatrists from malpractice suits or, rather, if it impedes providing quality psychiatric care and represents an economic burden that leads to more harm for the patient.

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Section: Discussionmentioning

confidence: 99%

Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists

et al. 2017

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“…(6) The study includes data from Europe. *USA,11 12 14 76–145 New Zealand,74 75 146 147 China,148–150 Japan,151 152 Iran,153 Israel,154–160 Sudan,161 Canada,162 163 Australia,164 165 South Africa,166 Singapore,167 India,168 Hong Kong,169 Brazil170 and one study from both USA, Canada and South Africa 73…”

Section: Resultsmentioning

confidence: 99%

How defensive medicine is defined in European medical literature: a systematic review

et al. 2022

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ObjectivesDefensive medicine has originally been defined as motivated by fear of malpractice litigation. However, the term is frequently used in Europe where most countries have a no-fault malpractice system. The objectives of this systematic review were to explore the definition of the term ‘defensive medicine’ in European original medical literature and to identify the motives stated therein.DesignSystematic review.Data sourcesPubMed, Embase and Cochrane, 3 February 2020, with an updated search on 6 March 2021.MethodsFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we reviewed all European original peer-reviewed studies fully or partially investigating ‘defensive medicine’.ResultsWe identified a total of 50 studies. First, we divided these into two categories: the first category consisting of studies defining defensive medicine by using a narrow definition and the second category comprising studies in which defensive medicine was defined using a broad definition. In 23 of the studies(46%), defensive medicine was defined narrowly as: health professionals’ deviation from sound medical practice motivated by a wish to reduce exposure to malpractice litigation. In 27 studies (54%), a broad definition was applied adding … or other self-protective motives. These self-protective motives, different from fear of malpractice litigation, were grouped into four categories: fear of patient dissatisfaction, fear of overlooking a severe diagnosis, fear of negative publicity and unconscious defensive medicine. Studies applying the narrow and broad definitions of defensive medicine did not differ regarding publication year, country, medical specialty, research quality or number of citations.ConclusionsIn European research, the narrow definition of defensive medicine as exclusively motivated by fear of litigation is often broadened to include other self-protective motives. In order to compare results pertaining to defensive medicine across countries, future studies are recommended to specify whether they are using the narrow or broad definition of defensive medicine.PROSPERO registration numberCRD42020167215.

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“…Table 1 showed the characteristics of the 27 studies involved in the review [ 2 , 12 , 14 , 15 , 17 – 23 , 27 – 42 ]. The included studies were published between 2002 and 2020 and distributed as follows: six in the USA [ 14 , 19 , 29 , 32 , 37 , 42 ], four in Italy [ 12 , 30 , 34 , 35 ], three in Israel [ 22 , 23 , 28 ], two studies per country, China [ 15 , 33 ],Turkey [ 2 , 21 ], Netherlands [ 38 , 41 ], UK [ 27 , 31 ],one study per country, Iran [ 17 ], Sudan [ 20 ], Japan [ 18 ]. Three studies were conducted as an international, the first in Canada, South Africa, and the USA [ 36 ], the second in nine countries in the Middle East [ 40 ], the third in 74 countries [ 39 ].…”

Section: Resultsmentioning

confidence: 99%

“…The occurrence of DM varies from one country to another and from one medical specialty to another, high rates were estimated 99.8% in Iran [ 17 ], 98.0% in Japan [ 18 ], 88.0% in the United States [ 19 ], 71.8 in Sudan [ 20 ], 72.0% in Turkey [ 21 ], 60.0% in Italy [ 12 ], and between 52.0 and 62.0% in Israel [ 22 , 23 ]. Based on the performed preliminary searches in databases: Scopus, Cochrane, and PubMed, several studies have been published investigating the occurrence of DM around the world and no review conducted on DM among physicians.…”

Section: Introductionmentioning

confidence: 99%

The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review

Kakemam

Arab‐Zozani

Raeissi

et al. 2022

BMC Health Serv Res

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Background Defensive Medicine (DM) concept refers to all medical care provided by physicians without increasing the benefits to the patient, the primary purpose of which is to prevent the risk of litigation. Although several studies have been published investigating the occurrence of DM around the world, no review conducted on DM among physicians. Therefore, this study aims to summarize and map the available evidence on occurrence, types of behaviors, and reasons for practicing of DM among physicians and possible solutions and strategies to reduce DM in the literature. Methods This is a scoping review in which we searched Web of Science, Scopus, and PubMed in December 2021. Our target was original studies of any type that included data on DM among physicians between 2000 and 2021. We followed the JBI guideline for conducting a scoping review and for increasing the rigor of the study. First, the percentage was used to summarize the occurrence of DM, and then, findings related to types of behaviors and reasons for practicing DM and mitigation strategies were analyzed inductively in NVivo 10 in three stages. Results Twenty-seven studies were included in the review. The overall occurrence of DM practice ranged from 6.7 to 99.8%. Two types of DM behaviors including assurance and avoidance behaviors have been identified. The common reasons for practicing DM were categorized into four themes, patient-related reasons, physician-related reasons, organization-related reasons, and society-related reasons. The main strategies to prevent or reduce DM are structured training and education, restoring physician-patient relationships, reform of the health system, and reform of the liability system. Conclusions The vast majority of research studies were conducted in high-income countries, and studies are needed to measure this phenomenon and its consequences in depth in low- and middle-income countries. Various solutions and strategies are needed to reduce defensive behaviors such as structured training and education, restoring physician-patient relationships, reforming the health system, and reforming the liability system. Keywords Defensive medicine, Defensive practice, Medical malpractice, Physicians, Scoping review

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Defensive Medicine Among Plastic and Aesthetic Surgeons in Israel

Abstract: DM is highly integrated into the daily medical practices of plastic surgeons in Israel.

Cited by 11 publications

References 14 publications

Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists

Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists

How defensive medicine is defined in European medical literature: a systematic review

The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review

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