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Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study

BACKGROUND: Medical errors, unsatisfactory outcomes, or treatment complications often prompt patient complaints about healthcare providers. In response, physicians may adopt defensive practices to mitigate objections, avoid complaints, and navigate lengthy trial processes or other potential threats....

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Autores principales: Eftekhari, Mohammad Hossein, Parsapoor, Alireza, Ahmadi, Ayat, Yavari, Neda, Larijani, Bagher, Gooshki, Ehsan Shamsi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563204/
https://www.ncbi.nlm.nih.gov/pubmed/37817191
http://dx.doi.org/10.1186/s12910-023-00949-2
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author Eftekhari, Mohammad Hossein
Parsapoor, Alireza
Ahmadi, Ayat
Yavari, Neda
Larijani, Bagher
Gooshki, Ehsan Shamsi
author_facet Eftekhari, Mohammad Hossein
Parsapoor, Alireza
Ahmadi, Ayat
Yavari, Neda
Larijani, Bagher
Gooshki, Ehsan Shamsi
author_sort Eftekhari, Mohammad Hossein
collection PubMed
description BACKGROUND: Medical errors, unsatisfactory outcomes, or treatment complications often prompt patient complaints about healthcare providers. In response, physicians may adopt defensive practices to mitigate objections, avoid complaints, and navigate lengthy trial processes or other potential threats. However, such defensive medicine (DM) practices can carry risks, including potential harm to patients and the imposition of unnecessary costs on both patients and the healthcare system. Moreover, these practices may run counter to accepted ethical standards in medicine. METHODS: This qualitative study involved conducting semi-structured interviews with 43 physicians, among whom 38 were faculty members at medical universities, 42 had administrative experience at various levels of the health system, and 23 had previously served as health system policymakers. On average, the participants had approximately 23.5 years of clinical experience. The selection of participants was based on purposive sampling. Data collection through interviews continued until data saturation was achieved. RESULTS: Based on the findings, DM manifests in both positive and negative forms, illustrated by instances like ordering unnecessary lab tests, imaging, or consultations, reluctance to admit high-risk patients, and avoiding high-risk procedures. The study participants identified a range of underlying and contextual factors contributing to DM, encompassing organizational-managerial, social, personal, and factors inherent to the nature of defensive medical practices. The results also highlight proposed strategies to address and prevent DM, which can be grouped into organizational-managerial, social, and those focused on modifying the medical complaints management system. CONCLUSION: DM is a multifaceted and significant phenomenon that necessitates a comprehensive understanding of its various aspects, including interconnected and complex structures and underlying and contextual factors. While the results of this study offer a solid foundation for informing policy decisions within the healthcare system and include some explanatory policy suggestions, we encourage policymakers to complement the findings of this study with other available evidence to address any potential limitations and to gain a more comprehensive understanding of the policymaking process related to DM. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12910-023-00949-2.
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spelling pubmed-105632042023-10-11 Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study Eftekhari, Mohammad Hossein Parsapoor, Alireza Ahmadi, Ayat Yavari, Neda Larijani, Bagher Gooshki, Ehsan Shamsi BMC Med Ethics Research BACKGROUND: Medical errors, unsatisfactory outcomes, or treatment complications often prompt patient complaints about healthcare providers. In response, physicians may adopt defensive practices to mitigate objections, avoid complaints, and navigate lengthy trial processes or other potential threats. However, such defensive medicine (DM) practices can carry risks, including potential harm to patients and the imposition of unnecessary costs on both patients and the healthcare system. Moreover, these practices may run counter to accepted ethical standards in medicine. METHODS: This qualitative study involved conducting semi-structured interviews with 43 physicians, among whom 38 were faculty members at medical universities, 42 had administrative experience at various levels of the health system, and 23 had previously served as health system policymakers. On average, the participants had approximately 23.5 years of clinical experience. The selection of participants was based on purposive sampling. Data collection through interviews continued until data saturation was achieved. RESULTS: Based on the findings, DM manifests in both positive and negative forms, illustrated by instances like ordering unnecessary lab tests, imaging, or consultations, reluctance to admit high-risk patients, and avoiding high-risk procedures. The study participants identified a range of underlying and contextual factors contributing to DM, encompassing organizational-managerial, social, personal, and factors inherent to the nature of defensive medical practices. The results also highlight proposed strategies to address and prevent DM, which can be grouped into organizational-managerial, social, and those focused on modifying the medical complaints management system. CONCLUSION: DM is a multifaceted and significant phenomenon that necessitates a comprehensive understanding of its various aspects, including interconnected and complex structures and underlying and contextual factors. While the results of this study offer a solid foundation for informing policy decisions within the healthcare system and include some explanatory policy suggestions, we encourage policymakers to complement the findings of this study with other available evidence to address any potential limitations and to gain a more comprehensive understanding of the policymaking process related to DM. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12910-023-00949-2. BioMed Central 2023-10-10 /pmc/articles/PMC10563204/ /pubmed/37817191 http://dx.doi.org/10.1186/s12910-023-00949-2 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Eftekhari, Mohammad Hossein
Parsapoor, Alireza
Ahmadi, Ayat
Yavari, Neda
Larijani, Bagher
Gooshki, Ehsan Shamsi
Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study
title Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study
title_full Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study
title_fullStr Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study
title_full_unstemmed Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study
title_short Exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study
title_sort exploring defensive medicine: examples, underlying and contextual factors, and potential strategies - a qualitative study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10563204/
https://www.ncbi.nlm.nih.gov/pubmed/37817191
http://dx.doi.org/10.1186/s12910-023-00949-2
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