Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands

ObjectivesThis study investigated whether the attitudes of physicians towards justified and unjustified litigation, and their perception of patient pressure in demanding care, influence their use of defensive medical behaviours.DesignCross-sectional survey using exploratory factor analysis was condu...

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Bibliographic Details
Published in:BMJ open 2019-06, Vol.9 (6), p.e025108-e025108
Main Authors: Renkema, Erik, Ahaus, Kees, Broekhuis, Manda, Tims, Maria
Format: Article
Language:English
Subjects:
Adult
Attitude of Health Personnel
Attitudes
Behavior
Cross-Sectional Studies
Defensive Medicine - legislation & jurisprudence
Defensive Medicine - methods
Emotions
Factor Analysis, Statistical
Female
Health Services Research
Hospitals
Humans
Hypotheses
Litigation
Male
Medical ethics
Medical malpractice
Medicine
Middle Aged
Netherlands
Patient safety
Perceptions
Physicians
Physicians - psychology
Questionnaires
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Summary:ObjectivesThis study investigated whether the attitudes of physicians towards justified and unjustified litigation, and their perception of patient pressure in demanding care, influence their use of defensive medical behaviours.DesignCross-sectional survey using exploratory factor analysis was conducted to determine litigation attitude and perceived patient pressure factors. Regression analyses were used to regress these factors on to the ordering of extra tests or procedures (defensive assurance behaviour) or the avoidance of high-risk patients or procedures (defensive avoidance behaviour).SettingData were collected from eight Dutch hospitals.ParticipantsRespondents were 160 physicians and 54 residents (response rate 25%) of the hospital departments of (1) anaesthesiology, (2) colon, stomach and liver diseases, (3) gynaecology, (4) internal medicine, (5) neurology and (6) surgery.Primary outcome measuresRespondents’ application of defensive assurance and avoidance behaviours.Results‘Disapproval of justified litigation’ and ‘Concerns about unjustified litigation’ were positively related to both assurance (β=0.21, p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2018-025108