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Evaluation of Defensive Medicine Behaviours in Various Medical Specialties and Titles: A Cross-Sectional Survey Study

Yıl 2025, Cilt: 9 Sayı: 2, 80 - 89, 31.12.2025
https://doi.org/10.52148/ehta.1772439

Öz

Objective: Defensive medicine is increasingly prevalent among physicians worldwide, including in Turkey. This study aims to explore physicians’ views and tendencies regarding defensive medicine, define the concept and practices in light of the literature, and examine the reasons and consequences of such practices.
Material and Methods: A cross-sectional survey was conducted among 390 physicians working in Edirne province and its districts, using the Defensive Medicine Practices Attitude Scale.
Results: The most common positive defensive medicine practices reported were placing greater emphasis on informed consent forms, keeping more detailed patient records, and providing patients with more thorough explanations of medical procedures. The most common negative defensive practice was avoiding patients perceived as having a high likelihood of initiating legal action. Overall, 85% of the participants stated they were familiar with the concept of defensive medicine. Physicians with lower professional seniority, particularly those working in state or university hospitals, demonstrated a stronger tendency toward defensive practices.
Conclusion: This study, in line with previous research, shows that defensive medicine practices are widely adopted among physicians. To reduce these tendencies, it is essential to establish a healthcare system and legal framework that enable physicians to practice in accordance with ethical principles. Addressing the underlying factors driving defensive behaviors and implementing necessary improvements by healthcare authorities are crucial.

Etik Beyan

This study was approved by the Non-Interventional Scientific Research Ethics Committee of Trakya University Faculty of Medicine (Approval Date: November 28, 2022, Protocol No: 2022/384). Informed consent was obtained from all participating physicians, and the study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. The identities of participants were kept confidential, and the data were used solely for research purposes.

Destekleyen Kurum

During this study, no financial or material support was received from any pharmaceutical company directly related to the research topic, nor from any company providing or producing medical instruments or materials that could potentially influence the evaluation process of this study.

Kaynakça

  • 1. Baungaard, N., Skovvang, P. L., Assing Hvidt, E., Gerbild, H., Andersen, M. K., & Lykkegaard, J. (2022). How defensive medicine is defined in European medical literature: A systematic review.
  • 2. Summerton, N. (1995). Positive and negative factors in defensive medicine: A questionnaire study of general practitioners. BMJ, 310(6971), 27–29.
  • 3. Clarke, S., & Oakley, J. (Eds.). (2007). Informed consent and clinician accountability: The ethics of report cards on surgeon performance. Cambridge University Press.
  • 4. Catino, M. (2011). Why do doctors practice defensive medicine? The side-effects of medical litigation. Safety Science Monitor, 15(1), 1–12.
  • 5. Toraman, A., & Çarıkçı, I. H. (2019). Evaluation of the reasons for defensive medicine from the perspective of physicians. Süleyman Demirel University Visionary Journal, 10(23), 40–51.
  • 6. Banaz, M., & Yalçın Balcık, P. (2022). Examination of physicians' defensive medicine attitudes. Hacettepe Health Administration Journal, 25(3), 501–516.
  • 7. Başer, A., Kolcu, G., Çığırgil, Y., Kadınkız, B., & Öngel, K. (2014). Evaluation of the opinions of family physicians working in Izmir Karşıyaka district regarding defensive medicine practices. Smyrna Medical Journal, 16, 24.
  • 8. Zheng, J., Lu, Y., Li, W., Zhu, B., Yang, F., & Shen, J. (2023). Prevalence and determinants of defensive medicine among physicians: A systematic review and meta-analysis. International Journal for Quality in Health Care, 35(4).
  • 9. Moosazadeh, M., Movahednia, M., Movahednia, N., Amiresmaili, M., & Aghaei, I. (2014). Determining the frequency of defensive medicine among general practitioners in Southeast Iran. International Journal of Health Policy and Management, 2(3), 119–123.
  • 10. Calikoglu, E. O., & Aras, A. (2020). Defensive medicine among different surgical disciplines: A descriptive cross-sectional study. Journal of Forensic and Legal Medicine, 73, 101970.
  • 11. Renkema, E., Ahaus, K., Broekhuis, M., & Tims, M. (2019). Triggers of defensive medical behaviours: A cross-sectional study among physicians in the Netherlands.
  • 12. Hiyama, T., Yoshihara, M., Tanaka, S., Urabe, Y., Ikegami, Y., Fukuhara, T., et al. (2006). Defensive medicine practices among gastroenterologists in Japan. World Journal of Gastroenterology, 12(47), 7671–7675.
  • 13. Williams, P. L., Williams, J. P., & Williams, B. R. (2021). The fine line of defensive medicine. Journal of Forensic and Legal Medicine, 80, 102170.
  • 14. Yan, S. C., Hulsbergen, A. F. C., Muskens, I. S., van Dam, M., Gormley, W. B., Broekman, M. L. D., & Smith, T. R. (2017). Defensive medicine among neurosurgeons in the Netherlands: A national survey. Acta Neurochirurgica, 159(12), 2341–2350.
  • 15. Solaroglu, I., Izci, Y., Yeter, H. G., Metin, M. M., & Keles, G. E. (2014). Health transformation project and defensive medicine practice among neurosurgeons in Turkey.
  • 16. Elli, L., Tenca, A., Soncini, M., Spinzi, G., Buscarini, E., & Conte, D. (2013). Defensive medicine practices among gastroenterologists in Lombardy: Between lawsuits and the economic crisis. Digestive and Liver Disease, 45(6), 469–473.
  • 17. Saraç, L. (2020). Attitudes and behaviors of contracted family physicians and family medicine specialists regarding defensive medicine practices (Master’s thesis). Health Sciences University, Ankara.
  • 18. Doğan, A., İncealtın, O., & Oğuz, A. (2023). Effect of defensive medicine on clinical practices of emergency medicine physicians. Global Emergency and Critical Care, 2(3), 117–121.
  • 19. Radwan, E., Albelbeisi, A. H., Al-Jedi, A., et al. (2025). Prevalence of defensive medicine behaviors, associated risk factors and its mitigation strategies among physicians in Gaza Strip, Palestine: A mixed method study. BMC Medical Ethics, 26, 145.
  • 20. Al-Balas, Q., Altawalbeh, S., Rinaldi, C., & Ibrahim, I. (2023). The practice of defensive medicine among Jordanian physicians: A cross-sectional study.
  • 21. Akdur, G. (2013). Attitudes of emergency physicians and research assistants working in emergency departments of medical faculties and training and research hospitals towards defensive medical practices (Specialty thesis). Trakya University, Edirne.
  • 22. Özgün, Ü. (2020). Defensive medicine practices, precursors and consequences (Doctoral dissertation). Sakarya University, Sakarya.
  • 23. Sarıcaoğlu, F., Akıncı, S. B., Erden, İ. A., Aypar, Ü., & Köseoğlu, A. (2013). An investigation of defensive medicine practices in anesthetists. Anestezi Dergisi, 21(3), 151–156.
  • 24. Turkish Medical Association Central Council. (2016). Working report 2014–2016. Turkish Medical Association.
  • 25. Yardım, M., & Eser, E. (2017). How many minutes should be allocated per patient for outpatient diagnosis and treatment applications? Turkish Journal of Public Health, 15(1), 58–67.
  • 26. Göçen, Ö., Yılmaz, A., Aslanhan, H., Celepkolu, T., Tuncay, S., & Dirican, E. (2018). Knowledge and attitudes of physicians about defensive medicine practices, job-related stress, and burnout levels. Turkish Journal of Family Medicine and Primary Care, 12(2), 77–87.
  • 27. Altındiş, S., Coşar, E., Atasoy, A. R., Akbaba, B., Şimşir, İ., & Öz, S. (2019). Defensive medicine in healthcare practices. Balıkesir Medical Journal, 3(1), 12–19.
  • 28. Nahed, B. V., Babu, M. A., Smith, T. R., & Heary, R. F. (2012). Malpractice liability and defensive medicine: A national survey of neurosurgeons.
  • 29. Panella, M., Rinaldi, C., Leigheb, F., Donnarumma, C., Kul, S., Vanhaecht, K., et al. (2016). The determinants of defensive medicine in Italian hospitals: The impact of being a second victim. Revista de Calidad Asistencial, 31, 20–25.
  • 30. Selçuk, M. (2015). Defensive medicine (Master’s thesis). İzmir University, İzmir.
  • 31. Kalkan, E., Özer, K., İzci, E., & Erdi, M. F. (2020). A study on defensive medicine practices of brain and neurosurgery specialists in the face of medical malpractice lawsuits. Journal of Healthcare Management Leadership, 1, 54–69.
  • 32. Biçen, E. (2018). Investigation of the attitudes of medical specialty students regarding defensive medicine (Specialty thesis). Dokuz Eylül University, İzmir.
  • 33. Yeşiltaş, A., & Erdem, R. (2018). A qualitative study on violence and defensive medicine practices. Journal of Academic Social Science, 74(74), 486–500.
  • 34. Zarei, E., Ashtar-Nakhaei, F., Daneshkohan, A., & Zali, A. (2019). The first survey on defensive medicine among Iranian surgeons: Prevalence and its related factors. Archives of Iranian Medicine, 22(9), 486–492.
  • 35. Tebano, G., Dyar, O. J., Beovic, B., Béraud, G., Thilly, N., Pulcini, C., et al. (2018). Defensive medicine among antibiotic stewards: The international ESCMID AntibioLegalMap survey. Journal of Antimicrobial Chemotherapy, 73(7), 1989–1996.
  • 36. Arafa, A., et al. (2023). Defensive medicine practices as a result of malpractice claims and workplace violence among Egyptian physicians. Scientific Reports, 13(1), 14853.

Yıl 2025, Cilt: 9 Sayı: 2, 80 - 89, 31.12.2025
https://doi.org/10.52148/ehta.1772439

Öz

Kaynakça

  • 1. Baungaard, N., Skovvang, P. L., Assing Hvidt, E., Gerbild, H., Andersen, M. K., & Lykkegaard, J. (2022). How defensive medicine is defined in European medical literature: A systematic review.
  • 2. Summerton, N. (1995). Positive and negative factors in defensive medicine: A questionnaire study of general practitioners. BMJ, 310(6971), 27–29.
  • 3. Clarke, S., & Oakley, J. (Eds.). (2007). Informed consent and clinician accountability: The ethics of report cards on surgeon performance. Cambridge University Press.
  • 4. Catino, M. (2011). Why do doctors practice defensive medicine? The side-effects of medical litigation. Safety Science Monitor, 15(1), 1–12.
  • 5. Toraman, A., & Çarıkçı, I. H. (2019). Evaluation of the reasons for defensive medicine from the perspective of physicians. Süleyman Demirel University Visionary Journal, 10(23), 40–51.
  • 6. Banaz, M., & Yalçın Balcık, P. (2022). Examination of physicians' defensive medicine attitudes. Hacettepe Health Administration Journal, 25(3), 501–516.
  • 7. Başer, A., Kolcu, G., Çığırgil, Y., Kadınkız, B., & Öngel, K. (2014). Evaluation of the opinions of family physicians working in Izmir Karşıyaka district regarding defensive medicine practices. Smyrna Medical Journal, 16, 24.
  • 8. Zheng, J., Lu, Y., Li, W., Zhu, B., Yang, F., & Shen, J. (2023). Prevalence and determinants of defensive medicine among physicians: A systematic review and meta-analysis. International Journal for Quality in Health Care, 35(4).
  • 9. Moosazadeh, M., Movahednia, M., Movahednia, N., Amiresmaili, M., & Aghaei, I. (2014). Determining the frequency of defensive medicine among general practitioners in Southeast Iran. International Journal of Health Policy and Management, 2(3), 119–123.
  • 10. Calikoglu, E. O., & Aras, A. (2020). Defensive medicine among different surgical disciplines: A descriptive cross-sectional study. Journal of Forensic and Legal Medicine, 73, 101970.
  • 11. Renkema, E., Ahaus, K., Broekhuis, M., & Tims, M. (2019). Triggers of defensive medical behaviours: A cross-sectional study among physicians in the Netherlands.
  • 12. Hiyama, T., Yoshihara, M., Tanaka, S., Urabe, Y., Ikegami, Y., Fukuhara, T., et al. (2006). Defensive medicine practices among gastroenterologists in Japan. World Journal of Gastroenterology, 12(47), 7671–7675.
  • 13. Williams, P. L., Williams, J. P., & Williams, B. R. (2021). The fine line of defensive medicine. Journal of Forensic and Legal Medicine, 80, 102170.
  • 14. Yan, S. C., Hulsbergen, A. F. C., Muskens, I. S., van Dam, M., Gormley, W. B., Broekman, M. L. D., & Smith, T. R. (2017). Defensive medicine among neurosurgeons in the Netherlands: A national survey. Acta Neurochirurgica, 159(12), 2341–2350.
  • 15. Solaroglu, I., Izci, Y., Yeter, H. G., Metin, M. M., & Keles, G. E. (2014). Health transformation project and defensive medicine practice among neurosurgeons in Turkey.
  • 16. Elli, L., Tenca, A., Soncini, M., Spinzi, G., Buscarini, E., & Conte, D. (2013). Defensive medicine practices among gastroenterologists in Lombardy: Between lawsuits and the economic crisis. Digestive and Liver Disease, 45(6), 469–473.
  • 17. Saraç, L. (2020). Attitudes and behaviors of contracted family physicians and family medicine specialists regarding defensive medicine practices (Master’s thesis). Health Sciences University, Ankara.
  • 18. Doğan, A., İncealtın, O., & Oğuz, A. (2023). Effect of defensive medicine on clinical practices of emergency medicine physicians. Global Emergency and Critical Care, 2(3), 117–121.
  • 19. Radwan, E., Albelbeisi, A. H., Al-Jedi, A., et al. (2025). Prevalence of defensive medicine behaviors, associated risk factors and its mitigation strategies among physicians in Gaza Strip, Palestine: A mixed method study. BMC Medical Ethics, 26, 145.
  • 20. Al-Balas, Q., Altawalbeh, S., Rinaldi, C., & Ibrahim, I. (2023). The practice of defensive medicine among Jordanian physicians: A cross-sectional study.
  • 21. Akdur, G. (2013). Attitudes of emergency physicians and research assistants working in emergency departments of medical faculties and training and research hospitals towards defensive medical practices (Specialty thesis). Trakya University, Edirne.
  • 22. Özgün, Ü. (2020). Defensive medicine practices, precursors and consequences (Doctoral dissertation). Sakarya University, Sakarya.
  • 23. Sarıcaoğlu, F., Akıncı, S. B., Erden, İ. A., Aypar, Ü., & Köseoğlu, A. (2013). An investigation of defensive medicine practices in anesthetists. Anestezi Dergisi, 21(3), 151–156.
  • 24. Turkish Medical Association Central Council. (2016). Working report 2014–2016. Turkish Medical Association.
  • 25. Yardım, M., & Eser, E. (2017). How many minutes should be allocated per patient for outpatient diagnosis and treatment applications? Turkish Journal of Public Health, 15(1), 58–67.
  • 26. Göçen, Ö., Yılmaz, A., Aslanhan, H., Celepkolu, T., Tuncay, S., & Dirican, E. (2018). Knowledge and attitudes of physicians about defensive medicine practices, job-related stress, and burnout levels. Turkish Journal of Family Medicine and Primary Care, 12(2), 77–87.
  • 27. Altındiş, S., Coşar, E., Atasoy, A. R., Akbaba, B., Şimşir, İ., & Öz, S. (2019). Defensive medicine in healthcare practices. Balıkesir Medical Journal, 3(1), 12–19.
  • 28. Nahed, B. V., Babu, M. A., Smith, T. R., & Heary, R. F. (2012). Malpractice liability and defensive medicine: A national survey of neurosurgeons.
  • 29. Panella, M., Rinaldi, C., Leigheb, F., Donnarumma, C., Kul, S., Vanhaecht, K., et al. (2016). The determinants of defensive medicine in Italian hospitals: The impact of being a second victim. Revista de Calidad Asistencial, 31, 20–25.
  • 30. Selçuk, M. (2015). Defensive medicine (Master’s thesis). İzmir University, İzmir.
  • 31. Kalkan, E., Özer, K., İzci, E., & Erdi, M. F. (2020). A study on defensive medicine practices of brain and neurosurgery specialists in the face of medical malpractice lawsuits. Journal of Healthcare Management Leadership, 1, 54–69.
  • 32. Biçen, E. (2018). Investigation of the attitudes of medical specialty students regarding defensive medicine (Specialty thesis). Dokuz Eylül University, İzmir.
  • 33. Yeşiltaş, A., & Erdem, R. (2018). A qualitative study on violence and defensive medicine practices. Journal of Academic Social Science, 74(74), 486–500.
  • 34. Zarei, E., Ashtar-Nakhaei, F., Daneshkohan, A., & Zali, A. (2019). The first survey on defensive medicine among Iranian surgeons: Prevalence and its related factors. Archives of Iranian Medicine, 22(9), 486–492.
  • 35. Tebano, G., Dyar, O. J., Beovic, B., Béraud, G., Thilly, N., Pulcini, C., et al. (2018). Defensive medicine among antibiotic stewards: The international ESCMID AntibioLegalMap survey. Journal of Antimicrobial Chemotherapy, 73(7), 1989–1996.
  • 36. Arafa, A., et al. (2023). Defensive medicine practices as a result of malpractice claims and workplace violence among Egyptian physicians. Scientific Reports, 13(1), 14853.
Toplam 36 adet kaynakça vardır.

Ayrıntılar

Birincil Dil İngilizce
Konular Birinci Basamak Sağlık Hizmetleri, Hasta Güvenliği, Sağlık Kurumları Yönetimi, Sağlık Sistemleri, Sağlık Yönetimi
Bölüm Araştırma Makalesi
Yazarlar

Gökçe Öz Nalbant 0000-0002-0912-569X

Gönderilme Tarihi 26 Ağustos 2025
Kabul Tarihi 24 Kasım 2025
Yayımlanma Tarihi 31 Aralık 2025
Yayımlandığı Sayı Yıl 2025 Cilt: 9 Sayı: 2

Kaynak Göster

APA Öz Nalbant, G. (2025). Evaluation of Defensive Medicine Behaviours in Various Medical Specialties and Titles: A Cross-Sectional Survey Study. Eurasian Journal of Health Technology Assessment, 9(2), 80-89. https://doi.org/10.52148/ehta.1772439

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