The Prevalence of Defensive Medicine Behaviors among Surgeons, Its Causes and Potential Reduction Solutions: a Cross-Sectional Study in Iran

Defensive Medicine (DM) is defined as the deviation of a doctor from his or her usual behavior, and its aim to reduce or prevent complaints from patients or their families. This study aimed to investigate DM behaviors of the surgeons participating in the 41st Congress of Iranian Association of Surgeons (IAS) in 2017. In this cross-sectional study, 160 surgeons were selected using convenience sampling. The data gathering tool was a researcher-made questionnaire consisting of 60 items including 4 parts (demographic characteristics, the prevalence of DM behaviors, its causes and potential reduction solutions) that its validity and reliability were confirmed. For data analysis descriptive statistics including frequency, percentage, mean and standard deviation in SPSS 21 software were used. The prevalence of positive and negative DM behaviors was 100 and 80%, respectively. The most common positive DM behaviors included ordering unnecessary biopsy, imaging, and laboratory tests, and avoiding caring for high-risk patients and refusal to admit patients with a specific social status were the most common negative DM behaviors among surgeons. Lack of support of physicians by health system rules and regulations in adverse situations and fear of patient’s claim were the most important reason for DM behaviors. The most effective potential solutions to the DM reduction were team decision-making in case of complex patients, modification of the law’s view on medical malpractice as a crime, and more support of the legislature. All surveyed surgeons showed at least one of the varieties of DM behaviors, ultimately leading to increased health care costs and resources wasting as well as having negative impact on patient safety. Applying strategies such as modification of the medical malpractice rules and regulations, increasing supervision and monitoring of service provision, establishing appropriate adverse events reporting systems and blame-free culture, developing and implementing evidence-based medicine in practice and reforming of medical liability insurance can be effective steps in reducing DM