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BMJ open
06 25, 2019;9 (6): e025108.

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

Erik Renkema, Kees Ahaus, Manda Broekhuis, Maria Tims
Author Information
  1. Erik Renkema: Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
  2. Kees Ahaus: Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
  3. Manda Broekhuis: Department of Operations, Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
  4. Maria Tims: Department of Management and Organisation, School of Business and Economics, Amsterdam Business Research Institute, VU University Amsterdam, Amsterdam, The Netherlands.
PMID: 31243028 DOI: 10.1136/bmjopen-2018-025108

Abstract

OBJECTIVES: This 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.
DESIGN: Cross-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).
SETTING: Data were collected from eight Dutch hospitals.
PARTICIPANTS: Respondents 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 MEASURES: Respondents' 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<0.01, and β=0.28, p<0.001, respectively) and avoidance (β=0.16, p<0.05, and β=0.18, p<0.05, respectively) behaviours. 'Self-blame for justified litigation' was not significantly related to both defensive behaviours. Perceived patient pressures to refer (β=0.18, p<0.05) and to prescribe medicine (β=0.23, p<0.01) had direct positive relationships with assurance behaviour, whereas perceived patient pressure to prescribe medicine was also positively related to avoidance behaviour (β=0.14, p<0.05). No difference was found between physicians and residents in their defensive medical behaviour.
CONCLUSIONS: Physicians adopted more defensive medical behaviours if they had stronger thoughts and emotions towards (un)justified litigation. Further, physicians should be aware that perceived patient pressure for care can lead to them adopting defensive behaviours that negatively affects the quality and safety of patient care.

Keywords

medical ethics quality in health care risk management

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MeSH Term

Adult
Attitude of Health Personnel
Cross-Sectional Studies
Defensive Medicine
Factor Analysis, Statistical
Female
Humans
Male
Middle Aged
Netherlands
Physicians
Journal Article Multicenter Study
Article has an altmetric score of 1

Word Cloud

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