Abstract
BackgroundDefensive medicine is becoming increasingly prevalent in the United States and is estimated to cost billions of dollars in excess healthcare spending. There is evidence that the practice of defensive medicine starts early in the medical career. Defensive medicine has been investigated among residents in high medico-legal risk specialties, but there is a paucity of information on its prevalence among internal medicine residents.Objective To examine the prevalence and patterns of defensive medical practices among internal medicine residents.MethodsWe conducted an online survey among the residents of three internal medicine residency programs in the 2018-2019 academic cycle. We invited all internal medicine residents within the selected programs to participate through email and asked them to complete an electronic survey assessing defensive medical practices.ResultsA total of 49 out of 143 residents participated in the study (response rate: 34.3%); 55% (n = 27) of the residents who participated considered the risk of being sued during residency to be low, compared to 40.8% (n = 20) who considered it to be moderate and 4.1% (n = 2) who considered it to be high. Defensive medical practices were found to be widely prevalent (40.0-91.3%) among internal medicine residents across all three clinical training stages. Assurance defensive practices were more common than avoidance practices.ConclusionDefensive medical practices, especially of the assurance type, were widely prevalent among our sample of internal medicine residents.
Highlights
Defensive medicine is the deviation from routine medical care in order to avoid or reduce the risk of real or perceived future legal consequences [1,2]
A total of 49 out of 143 residents participated in the study; 55% (n = 27) of the residents who participated considered the risk of being sued during residency to be low, compared to 40.8% (n = 20) who considered it to be moderate and 4.1% (n = 2) who considered it to be high
Assurance defensive practices were more common than avoidance practices
Summary
Defensive medicine is the deviation from routine medical care in order to avoid or reduce the risk of real or perceived future legal consequences [1,2]. A study in 1984 estimated the national cost of defensive medicine to be 37 billion dollars per year, constituting 14% of the total healthcare costs [4]. Another study published in 1994 estimated the excess cost of defensive medicine to be over 41 billion dollars in a five-year period [5]. O’Leary et al published a study in 2012 comparing defensive medicine practices among third-year medical students and third-year residents in one institution among various specialties. The study found that both medical students and residents were often engaging in assurance practices They were being taught to take malpractice liability into consideration during clinical decision making [10]. Defensive medicine is becoming increasingly prevalent in the United States and is estimated to cost billions of dollars in excess healthcare spending. Defensive medicine has been investigated among residents in high medico-legal risk specialties, but there is a paucity of information on its prevalence among internal medicine residents
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