Abstract
Introduction: Defensive medicine is a medical practice in which health care providers' primary intent is to avoid criticism and lawsuits, rather than providing for patients' medical needs. The purpose of this study was to characterize medical students' exposure to defensive medicine during medical school rotations.Methods: We performed a cross-sectional survey study of medical students at the beginning of their third year. We gave students Likert scale questionnaires, and their responses were tabulated as a percent with 95% confidence interval (CI).Results: Of the 124 eligible third-year students, 102 (82%) responded. Most stated they rarely worried about being sued (85.3% [95% CI=77.1% to 90.9%]). A majority felt that faculty were concerned about malpractice (55.9% [95% CI=46.2% to 65.1%]), and a smaller percentage stated that faculty taught defensive medicine (32.4% [95% CI=24.1% to 41.9%]). Many students believed their satisfaction would be decreased by MC and lawsuits (51.0% [95% CI=41.4% to 60.5%]). Some believed their choice of medical specialty would be influenced by MC (21.6% [95% CI=14.7% to 30.5%]), and a modest number felt their enjoyment of learning medicine was lessened by MC (23.5% [95% CI=16.4% to 32.6%]). Finally, a minority of students worried about practicing and learning procedures because of MC (16.7% [95% CI=10.7% to 25.1%]).Conclusion: Although third-year medical students have little concern about being sued, they are exposed to malpractice concerns and taught considerable defensive medicine from faculty. Most students believe that fear of lawsuits will decrease their future enjoyment of medicine. However, less than a quarter of students felt their specialty choice would be influenced by malpractice worries and that malpractice concerns lessened their enjoyment of learning medicine. [West J Emerg Med. 2014;15(3):293–298.]
Highlights
Defensive medicine is a medical practice in which health care providers’ primary intent is to avoid criticism and lawsuits, rather than providing for patients’ medical needs
A majority felt that faculty were concerned about malpractice (55.9% [95% confidence interval (CI)=46.2% to 65.1%]), and a smaller percentage stated that faculty taught defensive medicine (32.4% [95% CI=24.1% to 41.9%])
Many students believed their satisfaction would be decreased by malpractice concern (MC) and lawsuits (51.0% [95% CI=41.4% to 60.5%])
Summary
Defensive medicine is a medical practice in which health care providers’ primary intent is to avoid criticism and lawsuits, rather than providing for patients’ medical needs. The ballooning cost of malpractice claims and insurance has ignited considerable healthcare policy debate and has generated the phenomenon known as defensive medicine (DM), defined as medical practices in which healthcare providers’ primary intent is to avoid criticism and lawsuits, rather than providing for patients’ medical needs.[1,2] . Positive DM, sometimes referred to as assurance behavior, involves the ordering of unnecessary or excessive diagnostic tests, procedures and referrals.[2,8] In a 2009 American Medical Association sponsored survey of 1,231 primary care physicians, surgical specialists, and nonsurgical specialists, 91.0% agreed that physicians order more tests and procedures than needed to protect themselves from malpractice suits. There were no statistical differences in responses across geography, type of practice, or professional society affiliation.[9]
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