Experience and Etiology of Defensive Medicine in View of Residents in Mashhad University of Medical Sciences in 2016

Document Type : Original Article

Authors

1 MSc, Health Services Management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

2 Associate Professor, Health Sciences Research Center, Department of Health and Management; School of Health, Mashhad, University of Medical Sciences, Mashhad, Iran

3 Assistant Professor, Health Sciences Research center, Department of Health and Management, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

4 PhD, Department of Biostatistics and Epidemiology, School of Health, Mashhad University of Medical Sciences, Mashhad, Iran

Abstract

Purpose:
Defensive medicine is concerned with decisions made to avoid errors that could result in serious consequences in terms of quality of care and efficient use of scarce health resources. This study aimed to assess the experience and etiology of defensive medicine from the perspective of residents in Mashhad University of Medical Sciences. 
Methods:
This descriptive cross-sectional study was conducted with all residents in Mashhad University of Medical Sciences in 2016. The questionnaire was designed to collect data. Data were recorded in SPSS software version 20. Using descriptive statistics and the statistical method of inferred, Friedman's test at a significance level of 0.05, was used. 
Results:
Experiencing defensive medicine was reported by 100% of the participants, such that 149 people 38.3% reported high level and 11 people 2.8% reported low level of experience. Defensive medicine was mostly adopted to avoid being sued by patients 87.2% and least due to lack of liability insurance and reduce the risk of loss of financial capital doctor, 43.7% have been reported.
Conclusion:
The results obtained suggest a high level of defensive medicine among residents in Mashhad University of Medical Sciences. Accordingly, it is recommended that training be provided to eliminate this phenomenon, and doctors be steered toward its positive aspects. And while that with quite simple measures will reduce this phenomenon.

Keywords


  1. Summerton N. Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ: British Medical Journal. 1995; 310(6971): 27-9.
  2. Rx M. Defensive medicine: Can it increase your malpractice risk? Current Psychiatry 2009; 8(12): 86.
  3. Haghshenas MR, Vahidshahi K, Ahmadzade Amiri A, Sheikh Rezaee MR, Rahmani N, PourhosseinM, et al. Study the frequency of malpractice lawsuits referred to forensic medicine department and medical council, Sari, 2006-2011. J Mazandaran Univ Med Sci 2012; 21(86): 244-51.[Persian]
  4.  Hickson GB, Federspiel CF, Pichert JW, Miller CS, Gauld-Jaeger J, et al. Patient complaints and malpractice risk. JAMA 2002; 287: 2951-2957.
  5.  Akhlaghi M, Tofighi Zavare H, Samadi F. The Sues of Gynecoobstetrics Referred to the Commission of National Legal Medicine Center at 2001-2002; Reasons and Methods of Prevention from these. Forensic Mwdicine 2009; 10(34): 70-4
  6.  J. T. Dove, J. E. Brush Jr., R. A. Chazal, and W. J. Oetgen. “Medical professional liability and health care system reform.” Journal of the American College of Cardiology 2010; 55(25): 2801–2803.
  7.  M. M. Mello, A. Chandra, A. A. Gawande, and D. M. Studdert. “National costs of the medical liability system.” Health Affairs 2010; 29(9): 1569–1577.
  8.  Charlatan F.Medical errors kill almost 10000 Americans a year[letter].BMJ 1999; 319:1519.
  9.  Harris MH.to err is human-the fallible physician. S D J Med 2004; 57(1): 9-11.
  10.  Sheikh Azadi A, Ghadyani MH, Kiani M.The Investigation Methods Forensic Mwdidcine 2007;13(3):171-80.
  11.  Rafizadeh Tabai Zavareh SM, Haj Manoochehri R & Nasaji Zavareh M. Study of General Physicians negligence frequency among complaints referred to tehran’s forensic medicine commission from 2003 to 2005. SJFM 2007; 13(3): 152-7. [Persian]
  12.  Levinson W, Roter DL, Mullooly JP.Physician-patient communication: therelationship with malpractice claims amongprimary care physicians and surgeons. JAMA 1999; 277: 553-559.
  13.  Asher E, Greenberg-Dotan S, Halevy J, Glick S, Reuveni H Defensive Medicine in Israel—a nationwide survey. Plos One 2012; 7(8):e42613.
  14. Asher E, Parag Y, Zeller L, Yerushalmi R, Reuveni H Unconscious defensive medicine: the case of erythrocyte sedimentation rate. Eur J Intern Med 2007; 18(1): 35-38.
  15.   G. Ridic, T. Howard, and O. Ridic, “Medical malpractice in Connecticut: defensive medicine, real problem or a red herring—example of assessment of quality outcomes variables.”Acta Informatica Medica 2012; 20(1): 32-39.
  16.  Studdert DM, Mello MM & Brennan TA. Medical malpractice. New England Journal of Medicine 2004; 350(3): 283-92.
  17.  Baicker K, Fisher ES, Chandra A Malpractice liability costs and the practice of medicine in the Medicare program. Health Affair 2007; 26(3): 841-852.
  18.  ismie.com [Internet]. Illinios State Mutural Insurance Company. © 2015 ISMIE Mutual Insurance Company Available from: https:// www.ismie.com/.
  19.  Moosazadeh M, Movahednia M, Movahednia N, Amiresmaili M, Aghaei I.  Determining the frequency of defensive medicine among general practitioners in Southeast Iran. Ijhpm 2014; 2(3): 119-123. [Persian]
  20.  Catino M. Why do Doctors practice defensive medicine? The side-effects of medical litigation. Safety Science Monitor 2011; 15(1): 1-12.
  21.  Anderson RE. Billions for defense: the pervasive nature of defensive medicine. Arch Intern Med 1999; 159(20): 2399-402.
  22.   Summerton N. Trends in negative defensive medicine within general practice. Br J Gen Pract 2000; 50(456): 565-6.
  23.  Solaroglu I, Izci Y, Gokce Yeter H, Mert Metin M, Evren Keles G. Health Transformation Project and Defensive Medicine Practice among Neurosurgeons in Turkey. PLOS ONE 2014; 9 (10).
  24.  Ortashi O, Virdee J, Hassan R, Mutrynowski T, Abu-Zidan F. The practice of defensive medicine among hospital doctors in the United Kingdom. BMC Medical Ethics 2013; 14: 42.
  25.  Asgary R, Lawrence K. Characteristics, determinants and perspectives of experienced medical humanitarians: a qualitative approach.2014 ;4doi: 10.1136/bmj.open-2014.
  26. Nelson LJ, Morrisey MA & Kilgore ML. Damages caps in medical malpractice cases. Milbank Quarterly 2007; 85(2): 259-86.
  27.  Sloan FA & Shadle JH. Is there empirical evidence for Defensive Medicine? A reassessment. Journal of Health Economics 2009; 28(2): 481-91.
  28.  Motta S, Testa D, Cesari U, Quaremba G , Motta G. Medical liability, defensive medicine and professional insurance in otolaryngology. BMC Res Notes 2015; 8: 343.