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At least 19 recordsLinked to original sources
PubMed1978

The problem of defensive medicine.

Defensive medicine--the use of diagnostic and end-treatment measures explicitly for the purposes of averting malpractice suits--is frequently cited as one of the least desirable effects of the current rise in medical litigation. Many physicians and policy-makers claim that defensive medicine is responsible not only for the increasing costs of health care but the exposing of patients to significant risks of harm from unnecessary procedures. Very little solid information is available about defensive medicine. The studies that have been conducted have been fraught with statistical difficulties and are by no means definitive. Even more important than the issue of defensive medicine is the more basic problem of our system of compensation for medical injuries.

Adult↗
PubMed2005

[Assertive medicine: a proposal against defensive medicine].

More than ever the physician-patient relationship is deteriorated by diverse factors, among these liability complaints stand out, and have propitiated the practice of defensive medicine, an attitude considered in many countries as inappropriate, expensive and unethical. Defensive medicine widens the distance between a physician and his patient. To revert this vice and its noxious effects which corrupt the patient-physician relationship in our country, we propose that physicians put to practice actions which permit the renewal of the essence of humanistic medicine in their daily practice and the restoration of the relationship. These changes in attitude sum up to a proposition of professional practice which we have denominated assertive medicine. This offer is resumed in four points: 1) Maintain a proper verbal and non verbal communication with each patient, 2) Keep continuously up to date skills, knowledge and abilities, 3) Respect the patient's rights and 4) Defend their own rights as physicians.

Assertiveness↗
PubMed2000

Defensive medicine during hospital obstetrical care: a byproduct of the technological age.

This paper presents an alternative perspective on defensive medicine. Defensive medicine is usually understood as arising from the effect of law on medicine through fear of litigation. Of equal significance, however, is the complementary influence of medicine on law through technological innovation, and, more importantly, the way that medicine and law develop dialectically. Each shapes the other in establishing the standards of care central to both clinical medicine and to actual or potential legal action. Excessive testing owing to fear of litigation indicates that defensive medicine is being practised in a particular setting, but it does not explain why this is so. To understand why defensive medicine occurs and why it is so troubling to clinicians requires an understanding, not only of medical and legal developments, but of a political-economic system and the beliefs and values of a society. Defensive medicine is discussed in relation to hospital obstetrical scenarios commonly associated with fear of litigation: fetal oxygen deprivation ("distress"), which is detected using an electronic fetal monitor, and prolonged labor, known as "dystocia". The material presented is taken from a medical anthropological study of obstetrical care in rural British Columbia, Canada. Litigation fears are shown to result less from rare, albeit often devastating, allegations of malpractice than from doctors adopting a role as "fetal champions", together with the introduction of electronic monitoring technology. The paper concludes by asserting that, rather than being in an adversarial relationship, medical practice and associated litigation primarily work together to reinforce each other, and the social conditions in which defensive medicine occurs.

British Columbia↗
PubMed2006

Defensive medicine practices among gastroenterologists in Japan.

AIM: To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. METHODS: A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006. The number of gastroenterologists reporting defensive medicine behaviors or changes in their scope of practice and the reported defensive medicine practices, i.e., assurance and avoidance behaviors, were examined. RESULTS: A total of 131 (77%) out of 171 gastroenterologists completed the survey. Three (2%) respondents were sued, and most respondents (96%) had liability insurance. Nearly all respondents (98%) reported practicing defensive medicine. Avoidance behaviors, such as avoiding certain procedures or interventions and avoiding caring for high-risk patients, were very common (96%). Seventy-five percent of respondents reported often avoiding certain procedures or interventions. However, seasoned gastroenterologists (those in practice for more than 20 years) adopted avoidance behaviors significantly less often than those in practice for less than 10 years. Assurance behaviors, i.e., supplying additional services of marginal or no medical value, were also widespread (91%). Sixty-eight percent of respondents reported that they sometimes or often referred patients to other specialists unnecessarily. CONCLUSION: Defensive medicine may be highly prevalent among gastroenterologists throughout Japan, with potentially serious implications regarding costs, access, and both technical and interpersonal quality of care.

Defensive Medicine↗
PubMed1979

Alternatives to defensive medicine.

The ethics of defensive medicine, as distinguished from unnecessary testing for reasons other than fear of malpractice suits, and the usefulness its practice affords the physician in court are sharply questioned. Physicians, patients, and society are all adversely affected by its practice. Alternatives are recommended that physicians and organized medicine can employ to minimize malpractice problems.

Clinical Competence↗
PubMed1996

Measuring defensive medicine using clinical scenario surveys.

For more than two decades, advocates of malpractice system reform have claimed that the most damaging and costly result of the U.S. medical malpractice system is the practice of defensive medicine, in which physicians order tests and procedures primarily because of fear of malpractice liability. In this article, we discuss the issues raised by different definitions of defensive medicine and propose a working definition to guide measurement of the concept. We also consider the strengths and weaknesses of available approaches for measuring defensive medicine. Finally, we describe an empirical approach to measuring defensive medicine using clinical scenario surveys. The results suggest that, if physicians actually practice as they say they would in these surveys, defensive medicine does exist, although not to the extent suggested by anecdotal evidence or direct physician surveys. The results also suggest that defensive medicine varies considerably across clinical situations. In all of the scenarios, many physicians chose aggressive patient management styles even though conservative management was considered medically acceptable by the expert panels that developed the scenarios. In most cases, medical indications, not malpractice concerns, motivated clinical choices. Our results highlight the limitations of surveys as a method of measuring the extent of defensive medicine. The implications of managed care and health care reform for defensive medicine are also discussed.

Attitude of Health Personnel↗
PubMed2005

Defensive medicine among high-risk specialist physicians in a volatile malpractice environment.

CONTEXT: How often physicians alter their clinical behavior because of the threat of malpractice liability, termed defensive medicine, and the consequences of those changes, are central questions in the ongoing medical malpractice reform debate. OBJECTIVE: To study the prevalence and characteristics of defensive medicine among physicians practicing in high-liability specialties during a period of substantial instability in the malpractice environment. DESIGN, SETTING, AND PARTICIPANTS: Mail survey of physicians in 6 specialties at high risk of litigation (emergency medicine, general surgery, orthopedic surgery, neurosurgery, obstetrics/gynecology, and radiology) in Pennsylvania in May 2003. MAIN OUTCOME MEASURES: Number of physicians in each specialty reporting defensive medicine or changes in scope of practice and characteristics of defensive medicine (assurance and avoidance behavior). RESULTS: A total of 824 physicians (65%) completed the survey. Nearly all (93%) reported practicing defensive medicine. "Assurance behavior" such as ordering tests, performing diagnostic procedures, and referring patients for consultation, was very common (92%). Among practitioners of defensive medicine who detailed their most recent defensive act, 43% reported using imaging technology in clinically unnecessary circumstances. Avoidance of procedures and patients that were perceived to elevate the probability of litigation was also widespread. Forty-two percent of respondents reported that they had taken steps to restrict their practice in the previous 3 years, including eliminating procedures prone to complications, such as trauma surgery, and avoiding patients who had complex medical problems or were perceived as litigious. Defensive practice correlated strongly with respondents' lack of confidence in their liability insurance and perceived burden of insurance premiums. CONCLUSION: Defensive medicine is highly prevalent among physicians in Pennsylvania who pay the most for liability insurance, with potentially serious implications for cost, access, and both technical and interpersonal quality of care.

Defensive Medicine↗
PubMedDate not supplied

[Defensive medicine in Mexico: an explorative survey of its characteristics].

INTRODUCTION: defensive medicine, has been recognized as a problem for health services in several countries of the world. It is defined as the application of treatments, tests and procedures with the main intention to defend the doctor of critic's and to avoid controversies, regarding diagnosis or patient's treatment. There are multiple causes of the defensive medicine: the fundamental is patient doctor relationship without the necessary trust. MATERIAL AND METHODS: the present reports it is a observational, cross-sectional and descriptive study of exploratory nature, with the objective to consider the dimension of the defensive medicine (MD) in Mexico. A survey was designed to pilot an application with Likert scale in a representative sample. 613 doctors participated to national level, with index of confidence of 95% and maximum error of 5% (p < 0.05). The questions explore the level in agreement or disagreement with perceptions, specific attitudes and conducts that are related to the MD practice. RESULTS: categories and degrees in the defensive practices of the interviewed doctors settled down, 38,7% were nondefensive, whereas 61,3% presented association with some MD degree (p < 0.05). CONCLUSIONS: The defensive attitude of the participant doctors is high, it emphasizes the importance of establishing measures that stimulate their containment and fights, which will allow to improve the quality of the medical practice and the doctor-patient relationship. The instrument maintained a degree of confidence and sensitivity (p < 0.05), that its future use allows.

Adult↗
PubMed1995

Positive and negative factors in defensive medicine: a questionnaire study of general practitioners.

OBJECTIVES: (a) To investigate defensive medical practices among general practitioners; (b) to compare any such practices with general practitioners' understanding of certain aspects of the terms of service and medical negligence and practitioners' concerns about the risk of being sued or having a complaint lodged. DESIGN: Postal questionnaire survey. Each questionnaire was followed by a reminder. SUBJECTS: 500 systematically selected general practitioners on the membership list of the Medical Defence Union. MAIN OUTCOME MEASURES: Answers to questions on defensive medical practices, understanding of certain aspects of the terms of service and medical negligence, and concerns about the risk of being sued or having a complaint lodged. RESULTS: 300 general practitioners returned the questionnaire (response rate 60%). 294 (98%) claimed to have made some practice changes as a result of the possibility of a patient complaining. Of the defensive medical practices adopted, the most common (over half of doctors stating likely or very likely) seemed to be increased diagnostic testing, increased referrals, increased follow up, and more detailed patient explanations and note taking. Respondents practised defensive medicine as a possible consequence of concerns about the risks of being sued or having a complaint lodged. This association was particularly strong for negative defensive practices. Defensive medical practice did not correlate with any misunderstanding about the law of negligence or the general practitioners' terms of service. CONCLUSIONS: General practitioners are practising defensive medicine. Some defensive practices such as increased patient explanations or more detailed note taking are clearly beneficial. However, implementing the findings of the Wilson report may increase negative defensive medical practices.

Adult↗
PubMed2000

["Defensive medicine" in the choice of cesarean section].

AIM: To evaluate the perception of "Defensive Medicine" by hospital obstetricians and the influence of this attitude on the choice of cesarean delivery. METHODS: Questionnaire sent by mail to a sample of obstetricians of general district, teaching and university hospitals in a region of southern Italy (Puglia). Doctors were selected as the head, the senior and the junior specialist of each department. Independent variables of the study were considered as demographic data of the subjects, seniority, interest in private practice, size of the hospital, background cesarean section rate, personal and site of work exposure to legal claims. Outcome measures were experience and confidence in training for operative vaginal and breech delivery, use of the partogram in labour, opinion about a trial of labour after a previous cesarean section and about section on request, personal perception of Defensive Medicine. Univariate and multivariate analysis of data were performed. RESULTS: The response rate was 83%. According to our data, seniority in service meant confidence in obstetrics manoeuvres and more will to teach them; size of hospitals was positively related to a more rationale approach of the diagnosis of dystocia; heads of units were more prone to accept the patient's wish for a cesarean section. Doctors with large private practices were less likely to be sued and the perception of legal pressure was directly related to the rate of cesarean section in each unit. CONCLUSIONS: Defensive Medicine is a reality that encompasses all categories of doctor in this survey. The only differences were in the rate of perception of legal pressure. We believe that residential programs should be modified in order to improve specialists' understanding of malpractice problems and that the patient-doctor relationship should be ameliorated in public hospitals.

Adult↗
PubMed1990

Defensive medicine: is legal protection the only motive?

This article on defensive medicine is the fifth in a periodic series of articles about rising healthcare costs. Specifically, the series explores healthcare expenditures on items other than direct patient care. The intent of the series is to indicate areas of hospital operations that may need trimming, particularly if executives want purchasers and payers of care to know that hospitals are doing everything they can to minimize costs without sacrificing quality of care. Like regulatory costs, which were covered in the last article, defensive medicine is sometimes beyond the control of hospitals. The first report of the series appeared Jan. 15; subsequent articles appeared April 30, Aug. 6 and Aug. 20.

Decision Making↗
PubMed1984

Physician perceptions of medical malpractice and defensive medicine.

Using judgments obtained in interviews with 33 Massachusetts physicians, the annual statewide volume of expenditures incurred for defensive medical reasons in 1982 was estimated to be $1.0 billion, 12% of all medical care expenditures. Estimates for the nation were $37 billion, 14% of expenditures. Nationally, 180,000 cesarean deliveries were thought to be performed for defensive motives. In their own institutions, respondents judged 43% of all skull x-rays following injury to be medically justified, 30% to be defensive medicine, 16% to be placebos, and 11% to be physician misjudgments. In considering the economic and noneconomic costs of medical malpractice procedures, the dollar costs of insurance were considered most serious, followed closely by defensive medicine, unfairness, and poorer relations with patients. Thirty-two percent of the responsibility for the negative aspects of malpractice processes was assigned to lawyers, 21% to physicians, 18% to legislatures and courts, 16% to patients, and 13% to insurance companies.

Attitude of Health Personnel↗