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

Abstract

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.

A pragmatic method to compare international critical care beds: Implications to pandemic preparedness and non‐pandemic planning

“…In other countries insurance status and commercial pressure to make a profit also play a part 54–56 . Defensive medicine also plays a role 57 …”

“…[54][55][56] Defensive medicine also plays a role. 57 Around 25%-30% of CCU patients are dead within 1 year, with most dying within 1 week. [58][59][60] Patients with a stay of longer than 30 days have an average age of 63 with 32% dying in the CCU, 42% die in hospital and 50% dying before 6 months.…”

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“…8 Recently conducted studies are placing the definition of DM in a broader context, that is, including gratuitous medical decisions and actions based on feelings of demand and pressure. 9,10 Defensive medical decision-making and behaviour may have various consequences for example, resulting in higher costs for the health care system and exposing patients to potential harm. [11][12][13][14][15] These consequences may deeply undermine the doctor−patient relationship.…”

“…Recently conducted studies are placing the definition of DM in a broader context, that is, including gratuitous medical decisions and actions based on feelings of demand and pressure 9,10 …”

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“…Defensive medicine is defined as medicine practiced in such a way as to reduce the risk of litigation for medical malpractice, usually by over-performing diagnostic tests [ 1 , 2 , 3 ]. Defensive medicine not only negatively affects the quality of healthcare, but also potentially contradicts the main ethical principle in medicine: “primum non nocere” (Latin for “first do no harm”) [ 4 , 5 , 6 , 7 ].…”