Abstract
BackgroundDefensive medicine is the practice of diagnostic or therapeutic measures conducted primarily as a safeguard against possible malpractice liability. We studied the extent, reasons, and characteristics of defensive medicine in the Israeli health care system.Methods and FindingsCross-sectional study performed in the Israeli health care system between April and July 2008 in a sample (7%) of board certified physicians from eight medical disciplines (internal medicine, pediatrics, general surgery, family medicine, obstetrics and gynecology, orthopedic surgery, cardiology, and neurosurgery). A total of 889 physicians (7% of all Israeli board certified specialists) completed the survey. The majority [60%, (95%CI 0·57–0·63)] reported practicing defensive medicine; 40% (95%CI 0·37–0·43) consider every patient as a potential threat for a medical lawsuit; 25% (95%CI 0·22–0·28) have previously been sued at least once during their career. Independent predictors for practicing defensive medicine were surgical specialty [OR = 1.6 (95%CI 1·2–2·2), p = 0·0004], not performing a fellowship abroad [OR = 1·5 (95%CI 1·1–2), p = 0·027], and previous exposure to lawsuits [OR = 2·4 (95%CI 1·7–3·4), p<0·0001]. Independent predictors for the risk of being sued during a physician's career were male gender [OR = 1·6 (95%CI 1·1–2·2), p = 0·012] and surgery specialty [OR = 3·2 (95%CI 2·4–4·3), p<0·0001] (general surgery, obstetrics and gynecology, orthopedic surgery, and neurosurgery).ConclusionsDefensive medicine is very prevalent in daily physician practice in all medical disciplines. It exposes patients to complications due to unnecessary tests and procedures, affects quality of care and costs, and undermines doctor-patient relationships. Further studies are needed to understand how to minimize defensive medicine resulting from an increased malpractice liability market.
Highlights
Defensive medicine is defined as the ordering of tests, procedures, and visits, or the avoidance of high-risk patients or procedures, primarily to reduce exposure to malpractice liability [1]
In cross-country comparisons between health care systems in the Organization for Economic Cooperation and Development (OECD) countries, the Israeli healthcare system was similar to the quality of care and technologically advanced to these countries
Researchers from the Faculty of Health Sciences and the Guilford Glazer School of Business and Management at the Ben-Gurion University of the Negev collaborated with the Israel Medical Association (IMA) to conduct the study
Summary
Defensive medicine is defined as the ordering of tests, procedures, and visits, or the avoidance of high-risk patients or procedures, primarily to reduce exposure to malpractice liability [1]. To avoid lawsuits non-evidence-based procedures are frequently used This has become deeply ingrained in many physicians’ practices resulting in ‘‘unconscious’’ defensive medicine [2]. Defensive medicine is expensive, has no basis in evidence-based studies, and sometimes exposes patients to complications due to unnecessary tests and procedures [3]. Defensive medicine prevalence and characteristics remain controversial [8,9] and to date no nationwide survey has been done to evaluate this phenomenon. In this study we performed for the first time a nationwide study to measure the extent and characteristics of defensive medicine among Israeli board certified expert physicians from high- and low-risk specialties. Reasons, and characteristics of defensive medicine in the Israeli health care system
Sign-in/Register to view highlights & summary Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
