Author:
Eftekhari Mohammad Hossein,Parsapoor Alireza,Ahmadi Ayat,Yavari Neda,Larijani Bagher,Gooshki Ehsan Shamsi
Abstract
Abstract
Background
Medical errors, unsatisfactory outcomes, or treatment complications often prompt patient complaints about healthcare providers. In response, physicians may adopt defensive practices to mitigate objections, avoid complaints, and navigate lengthy trial processes or other potential threats. However, such defensive medicine (DM) practices can carry risks, including potential harm to patients and the imposition of unnecessary costs on both patients and the healthcare system. Moreover, these practices may run counter to accepted ethical standards in medicine.
Methods
This qualitative study involved conducting semi-structured interviews with 43 physicians, among whom 38 were faculty members at medical universities, 42 had administrative experience at various levels of the health system, and 23 had previously served as health system policymakers. On average, the participants had approximately 23.5 years of clinical experience. The selection of participants was based on purposive sampling. Data collection through interviews continued until data saturation was achieved.
Results
Based on the findings, DM manifests in both positive and negative forms, illustrated by instances like ordering unnecessary lab tests, imaging, or consultations, reluctance to admit high-risk patients, and avoiding high-risk procedures. The study participants identified a range of underlying and contextual factors contributing to DM, encompassing organizational-managerial, social, personal, and factors inherent to the nature of defensive medical practices. The results also highlight proposed strategies to address and prevent DM, which can be grouped into organizational-managerial, social, and those focused on modifying the medical complaints management system.
Conclusion
DM is a multifaceted and significant phenomenon that necessitates a comprehensive understanding of its various aspects, including interconnected and complex structures and underlying and contextual factors. While the results of this study offer a solid foundation for informing policy decisions within the healthcare system and include some explanatory policy suggestions, we encourage policymakers to complement the findings of this study with other available evidence to address any potential limitations and to gain a more comprehensive understanding of the policymaking process related to DM.
Publisher
Springer Science and Business Media LLC
Subject
Health Policy,Health (social science),Issues, ethics and legal aspects
Reference27 articles.
1. Pellino IM, Pellino G. Consequences of defensive medicine, second victims, and clinical-judicial syndrome on surgeons’ medical practice and on health service. Updates Surg. 2015;67(4):331–7.
2. Sanatkar M, Sadrossadat SH, Ghassemi H, Ebrahim Soltani AR, Shaverdi MR, Bagheri H. The impact of a hospital ophthalmologic failures committee on patients’ complaints to forensics medical council. Tehran Univ Med J TUMS Publications. 2019;77(2):108–14.
3. Rafizadeh Tabai Zavareh SM, Haj Manoochehri R, Nasaji Zavareh M. Iran J Forensic Med. 2007;13(3):152–7.
4. Siabani S, Alipour AA, Siabani H, Rezaei M, Daniali S. A survey of complaints against physicians reviewed at Kermanshah Medical Council 2001–2005. J Kermanshah Univ Med Sci. 2009;13(1).
5. Sekhar MS, Vyas N. Defensive medicine: a bane to healthcare. Annals of Medical and Health Sciences Research. 2013;3(2):295–6.