Factors influencing defensive medicine‐based decision‐making in primary care: A scoping review

Abstract

Rationale, Aims and Objectives Medical decision‐making processes in primary care are influenced by defensive medical practice. This involves a high possibility for negative consequences on many levels, for example, patient's health, health care system costs and a crisis of trust in the patient−doctor relationship. Aim of this review was to identify factors of defensive medicine‐based decision‐making in primary care. Methods This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping reviews (PRISMA‐ScR) guidelines and included systematic research on MEDLINE, Google Scholar and two German databases for additional grey literature. References provided further literature. Articles in English and German published from 1 January 1982 to 15 June 2022 were assessed. Results From 911 publications screened, 13 publications [6 qualitative studies and 7 quantitative (3 cross‐sectional) studies] were included. In these, four main categories of factors influencing defensive medical practice were identified: (social) media, patients adopting a consumer attitude, health care system based working conditions and physician's tolerance for uncertainty. Pressure deriving from these four different sources is exerted on the general practitioner and may result in a defensive medical decision behaviour. Conclusions Four categories on influencing factors of defensive medicine could be identified. Strategies to tolerate uncertainty should be trained in under‐ and postgraduate training.