Defensive medicine practices, antecedents and outcomes

The main aim of this study is to identify physician perceptions of the practices, antecedents and outcomes of defensive medicine. In this contex, the study also attempts to develop scales to measure the practices, predictors and outcomes of defensive medicine. For this reason, the study was designed in four parts. The first part of the study includes a discussion on the national and international literature on the practice of defensive medicine. The second part presents the results of in-depth interviews held with 21 physicians from different branches using a semi-structured form designed based on the literature findings, which were analysed using NVivo 11 software. In the third part, scales were developed to measure physician perceptions of defensive medicine practices, antecedents of defensive medicine practices, and outcomes of defensive medicine practices based on the information obtained from the first and second parts of the study. In the last part, two models developed within the scope of the study were tested. The data were collected using the semi-structured interview form and scales developed for the purpose of the study. The scales were administered to 1724 physicians among 149.997 physicians working throughout Turkey. The data were analysed for validity and reliability. Descriptive statistics, correlation analysis, and multiple regression analysis were used in the data analysis. As a result of the in-depth interviews, it was found that the major antecedents of defensive medicine practices include concern about being complained and sued, pressure from patient complaint services, concern about being exposed to violence, the lack of support from management, and media. It was also found that the physicians most often demand additional tests, additional imaging, and additional consultation with respect to positive defensive medicine, while they most often turn to patient referral practice with respect to negative defensive medicine. With respect to the outcomes of defensive medicine, the physicians most often reported that defensive medicine practices pose risks for patients and increase health care spending. The findings obtained from the scales showed that the physicians use negative defensive medicine practices more often compared to positive defensive medicine practices. The most common negative defensive medicine practice was a patient referral, while the most common positive defensive medicine practice was additional tests and imagining. These results are consistent with those obtained from the qualitative data. Another result of the study is that the most important predictors of defensive medicine practices are pressure from the working environment and concern about being complained and sued, respectively. Additionally, the most important outcome of defensive medicine is that defensive medicine reduces the efficiency, effectiveness and quality of the health system. As a result of the testing of the models developed within the scope of the study, it was found that the physicians turn to positive and negative defensive medicine practices due to their concern about being complained and sued, pressure from mass media and social media, pressure from the working environment, concern about maintaining their reputation, concern about being exposed to violence, medical training that they received, and effort to adopt a patient-centered approach. It was also concluded that defensive medicine practices have negative consequences for physicians, patients, and the health system. Given the results of the study, it appears that Turkish physicians frequently use defensive medicine practices and defensive medicine practices have many negative outcomes.