The attitudes towards defensive medicine among physicians of obstetrics and gynaecology in China: a questionnaire survey in a national congress

OBJECTIVE: The study aimed to determine prevalence, patterns and risk factors of defensive medicine by obstetricians and gynaecologists across China. DESIGN: This is a questionnaire survey by written and on-line interview for participants. PARTICIPANTS: Among 1804 registered physicians participating at the 2017 Congress of Chinese Obstetricians and Gynecologists Association in Chengdu City, Sichuan Province, China, from 17 to 20 August 2017, 1486 participants (82.4%) responded the survey. MAIN OUTCOME MEASURES: Participants’ strongly disagreed/disagreed and strongly agreed/agreed options were compared to determine specific factors contributing to their preferences towards defensive medicine. RESULTS: In the whole cohort of 1486 participants, 903/1486 (60.8%), 283/1486 (19.0%) and 170/283 (60.1%) participants had experienced at least one medical dispute, lawsuit or loss of a lawsuit, respectively; and 1284 (86.4%) participants had witnessed their colleagues exposed to medical disputes, lawsuits or loss of a lawsuit. Generally, 62.9% of the participants strongly agreed or agreed with defensive medicine. Gender, administration duty, employment hospital, education status, subspecialty, exposure to any medical disputes, lawsuits or loss of a lawsuit, and colleagues’ experiences were independent risk factors relevant to participants’ preferences about defensive medicine in a multivariate model. Participants were more prone to accept or endorse defensive medicine if they were female physicians; without administrative duties; working in non-tertiary hospitals; with an undergraduate degree; with any exposure to medical disputes, lawsuits or loss of a lawsuit; or having witnessed colleagues’ similar experiences. CONCLUSIONS: About two-thirds of Chinese physicians practising obstetrics and gynaecology in our survey agreed with the practice of defensive medicine, but they had diverse preferences and understanding of specific practices, harms of defensive medicine and physician’s roles.