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Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey

Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on...

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Autores principales: Morena, Donato, Di Fazio, Nicola, Scognamiglio, Pasquale, Delogu, Giuseppe, Baldari, Benedetta, Cipolloni, Luigi, Frati, Paola, Fineschi, Vittorio
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673589/
https://www.ncbi.nlm.nih.gov/pubmed/38003977
http://dx.doi.org/10.3390/medicina59111928
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author Morena, Donato
Di Fazio, Nicola
Scognamiglio, Pasquale
Delogu, Giuseppe
Baldari, Benedetta
Cipolloni, Luigi
Frati, Paola
Fineschi, Vittorio
author_facet Morena, Donato
Di Fazio, Nicola
Scognamiglio, Pasquale
Delogu, Giuseppe
Baldari, Benedetta
Cipolloni, Luigi
Frati, Paola
Fineschi, Vittorio
author_sort Morena, Donato
collection PubMed
description Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75–7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50–3.46, p < 0.001). Prioritizing protection from professional liability over patients’ actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a ‘risk management culture’ and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine.
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spelling pubmed-106735892023-10-31 Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey Morena, Donato Di Fazio, Nicola Scognamiglio, Pasquale Delogu, Giuseppe Baldari, Benedetta Cipolloni, Luigi Frati, Paola Fineschi, Vittorio Medicina (Kaunas) Article Background: Defensive medicine is characterized by medical decisions made primarily as a precaution against potential malpractice claims. For psychiatrists, professional responsibility encompasses not only the appropriateness of diagnosis and treatment but also the effects of their interventions on patients and their behaviors. Objective: To investigate the socio-demographic, educational, and occupational characteristics and work-related attitudes that may serve as predictors of defensive medicine among Italian psychiatrists. This research extends the results of a previous analysis based on a national survey. Methods: A secondary analysis of the database of a national survey on attitudes and behaviors of Italian psychiatrists regarding defensive medicine and professional liability was performed for this study. Results: Among 254 surveyed psychiatrists, 153 admitted to practicing defensive medicine, while 101 had this attitude with less than half of their patients. The first group was predominantly comprised of women (p = 0.014), who were younger in age (43.34 y 9.89 vs. 48.81 y 11.66, p < 0.001) and had fewer years of professional experience (12.09 y ± 9.8 vs. 17.46 y ± 11.2, p < 0.001). There were no significant differences in prior involvement in complaints (p = 0.876) or the usual place of work (p = 0.818). The most prominent predictors for practicing defensive medicine were (1) considering guidelines and good clinical practices not only for their clinical efficacy but also or exclusively for reducing the risk of legal complaints for professional liability (OR = 3.62; 95%CI, 1.75–7.49), and (2) hospitalizing patients with violent intentions even if not warranted according to their mental state (OR = 2.28; 95%CI, 1.50–3.46, p < 0.001). Prioritizing protection from professional liability over patients’ actual needs in prescribing or adjusting drug dosages and in involuntary hospitalization, as well as prescribing lower dosages than recommended for pregnant patients, were identified as additional predictors. Finally, years of professional experience exhibited a protective function against defensive practices. Conclusions: Psychiatrists advocate the need to implement a ‘risk management culture’ and the provision of more balanced duties in order to ensure ethical and evidence-based care to their patients. A particular source of concern stems from their professional responsibility towards not only the health of patients but also their behavior. However, these aspects conflict with a limited potential for assessment and intervention based on effective clinical tools. A reform of professional liability that considers the specificities of patients cared for by mental health services could contribute to reducing the risk of defensive medicine. MDPI 2023-10-31 /pmc/articles/PMC10673589/ /pubmed/38003977 http://dx.doi.org/10.3390/medicina59111928 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Morena, Donato
Di Fazio, Nicola
Scognamiglio, Pasquale
Delogu, Giuseppe
Baldari, Benedetta
Cipolloni, Luigi
Frati, Paola
Fineschi, Vittorio
Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey
title Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey
title_full Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey
title_fullStr Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey
title_full_unstemmed Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey
title_short Predictors of Defensive Practices among Italian Psychiatrists: Additional Findings from a National Survey
title_sort predictors of defensive practices among italian psychiatrists: additional findings from a national survey
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10673589/
https://www.ncbi.nlm.nih.gov/pubmed/38003977
http://dx.doi.org/10.3390/medicina59111928
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