Evaluation of defensive medicine practices in physicians working in tokat province centre

Aim: Along with technological developments, standards of medical care and the quality of diagnostic and treatment procedures have also increased. Increased quality leads to an increase in patients' expectations of access to the best care and their concerns about not being able to access this care. This, in turn, damages the sense of trust, which is the basis of the physician-patient relationship, and leads to an increase in medical malpractice claims against physicians. As a result, physicians exhibit defensive medical behaviours in order to protect themselves from these allegations. In this study, it was aimed to determine the frequency of defensive (recessive) medical behaviours in physicians working in Tokat Gaziosmanpaşa University Research and Practice Hospital and Tokat State Hospital and the reasons that may cause these behaviours. Methods: This descriptive and cross-sectional study was conducted between 01.07.2022 and 01.11.2022. At the time of the research, a total of 485 specialists and general practitioners, 331 physicians working at Tokat Gaziosmanpaşa University Research and Application Hospital and 154 physicians working at Tokat State Hospital, constitute the universe of our research. Without calculating the sample size, it was aimed to reach all of the remaining 351 physicians after excluding physicians who are not in direct patient-physician relationship and physicians who are on administrative duty. A total of 322 (91,7%) physicians were reached. Ethics Committee Approval was approved by TOGU Faculty of Medicine Dean's Clinical Research Ethics Committee's decision with registration number 22-KAEK-120. In order to carry out the research, necessary permissions were obtained from the Tokat Provincial Health Directorate and the TOGU Health Research and Application Center Directorate. Research data, a questionnaire consisting of 48 questions including sociodemographic and occupational characteristics and defensive medicine antecedents, and Başer et al. It was obtained by using the Attitude Scale for Defensive Medicine Practices, the validity and reliability study of which was conducted in 2014. The scale consists of 18 questions and 3 sub-dimensions: Positive Defensive Medicine Practices Attitude Scale, Negative Defensive Medicine Practices Attitude Scale and Defensive Medicine Knowledge Level. Likert-type status meter choices were used in 14 questions measuring attitude. According to the total score obtained from the scale, the defensive medicine attitudes of the physicians are classified as "Very high", "High", "İntermediate" and "Low". After the data obtained as a result of the research were transferred to the computer environment, descriptive statistics, Pearson chi-square test, Fisher's exact chi-square test, ordinal regression analysis, multiple logistic regression analysis, Binary logistic regression analysis, Kruskal-Wallis H test, nonparametric multiple linear regression analysis and explanatory factor analysis were performed using IBM SPSS 29.0 package program. The IBM AMOS 26 package program was used in the confirmatory factor analysis of the Defensive Medicine Practices Attitude Scale, and the SmartPLS 4 package program was used in the structural equation model and finite mixture latent class analysis. Statistical significance level was accepted as p<0.05. Results: Of the 322 physicians who participated in our study, 41% (n=132) were female and 59% (n=190) were male. The mean age was 35.07±8.37 years, the youngest was 24 years old and the oldest was 62 years old. While 59.3% of the physicians were working in a university hospital, 40.7% were working in a state hospital. The mean total score of the Defensive Medicine Practices Attitude Scale of physicians was 46.95±11.18 and was found to be at a high level. It has been observed that the physicians' thinking that they have received adequate training, the state of being concerned about being complained, and the fear of making a mistake are effective in defensive medicine practices (p:0.005; <0.001; <0.001). In addition, it was determined that the perception of the possibility of encountering a malpractice lawsuit and being extra anxious in the Covid 19 pandemic were significantly related to defensive medicine practices (p:<0.001; 0,030). Conclusion: It was determined that the physicians participating in our study practiced defensive medicine at a high level. Defensive medicine practices cause many negative consequences. It puts physicians in legally untenable situations, negatively affects patient safety, and undermines health care delivery by causing misuse of limited resources. In this respect, it can be considered as a public health problem. There is a need for holistic and innovative health policies covering medical, legal, economic and sociocultural perspectives in order to prevent the negative consequences caused by defensive medical practices. Key words: Defensive Medicine, Physician, Malpractice