Effects of defensive medicine practices on health care in southeast Turkey

Abstract

Aim: In our country, the stress experienced by physicians due to their working conditions and intense workload plays a role in the formation of medical errors, therefore, physicians want to protect themselves from litigation processes with defensive medicine practices. The aim of our study is to evaluate the effects of defensive medicine practices on health service delivery. Material and Method: In our study, the knowledge and attitudes of a total of 175 dentists working in Dicle University Faculty of Dentistry and Diyarbakir Oral and Dental Health Hospital and its affiliated centers about defensive medicine practices, age, physician (service) duration, gender, institution, title and specialty areas, if any, the relationship was examined using the knowledge level measurement questionnaire. While performing statistical analysis, Chi-square Test was used for comparisons. Result: It was observed that 32% of the physicians in the 26-40 age group, who constitute the vast majority (71.4%) of the participants in the study, were not aware of the concept of defensive medicine. It was found that 36.6% of the participants, 84.4% of those with 1-5 years of medical experience, and 83.3% of the specialty students with the largest share, with the largest share, did not know this concept at all. Conclusion: It is found that most of the physicians do not have the necessary knowledge about medical errors and malpractice. While the level of knowledge is increased through in-service training programs, seminars and conferences about malpractice, medical errors, defensive medicine practices, the experience of experienced physicians can be used in preventing and solving problems.

Keywords

• Malpractice
• defensive medicine practices
• healthcare personnel awareness

References

1. Kuzgun U. Complication or Malpractice? TOTBID Derg 2019; 18: 98-101.
2. Kahriman İ, Ozturk H. Evaluating Medical Errors Made by Nurses During Their Diagnosis, Treatment and Care Practices. J Clin Nurs 2016; 25: 2884-94.
3. Bakir EP, Bakir S, Unal S, Uysal E. The effect of restorative dentistry practices on the vital signs of healthy individuals. J Health Sci Med 2021; 4: 434-40.
4. Flotta D, Rizza P, Bianco A, Pileggi C, Pavia M. Patient safety and medical errors: knowledge, attitudes and behavior among ıtalian hospital physicians. Int J Quality Health Care 2012; 24: 258-65.
5. Ozer O, Tastan K, Set T, Cayir Y, Sener M. Tibbi hatali uygulamalar. Dicle Tip Derg 2015; 42: 394-7.
6. Karatas M, Yakinci C. Tibbi hata nedenleri ve çözüm yolları. Inönü Üniv Tıp Fak Derg 2010; 17: 233-6.
7. Bakir EP, Bakir S, Unal S, Sonkaya E. Are healthcare professionals sufficiently aware of dental ethics? Fields research in southeast Turkey. Biotechnol Biotechnologic Equip 2021; 35: 325-33.
8. Yesiltas A. Erdem R. A qualitative study of violence and defensive medicine practices. Akademik Sosyal Arastirmalar Derg 2018; 6: 486-500.

9. Montanera D. The importance of negative defensive medicine in the effects of malpractice reform. Eur J Health Econ 2016; 17: 355-69.
10. Studdert DM, Mello MM, Sage WM, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 2005; 1: 2609-17.
11. Hiyama T, Yoshihara M, Tanaka S, et al. Defensive medicine practices among gastroenterologists in Japan. World J Gastroenterol 2006; 12: 7671-5.
12. Yilmaz K, Polat O, Kocamaz B. The legal analysis of defensive medicine acts. Turkiye Adalet Akademisi Derg 2014; 5: 19-51.
13. Toraman A, Carikci IH. The evaluation of the causes of defensive medicines with the vision of physicians. Süleyman Demirel Üniv Vizyoner Derg 2019; 10: 40-51.
14. Johnston WF, Rodriguez RM, Suarez D, Fortman J. Study of medical students' malpractice fear and defensive medicine: a "hidden curriculum?" West J Emerg Med 2014; 15: 293-8.
15. Moosazadeh M, Movahednia M, Movahednia N, Amiresmaili M, Aghaei I. Determining the frequency of defensive medicine among general practitioners in Southeast Iran. IJHPM 2014; 2: 119-23.
16. O’Leary KJ, Choi J, Watson K, Williams MV. Medical students' and residents' clinical and educational experiences with defensive medicine. Acad Med 2012; 87: 142-8.
17. Motta S, Testa D, Cesari U, Quaremba G, Motta G. Medical liability, defensive medicine and professional ınsurance ın otolaryngology. BMC Res Notes 2015; 8: 343.
18. Arikan A, Cinarli S, Aykar FS, Sayan A. Attitudes of medical malpractice in pediatric surgery. J Pediatr Res 2017; 4: 117-22.
19. Teke HY, Alkan HA, Basbulut AZ, Canturk G. Aspect of physicians and learning level to legal regulation about with malpractice: questionnaire training. Turkiye Klinikleri J Foren Med 2007; 4: 61-7.
20. Yildirim A, Aksu M, Cetin İ, Sahan AG. Knowledge of and attitudes towards malpractice among physicians in Tokat, Turkey. Cumhuriyet Med J 2009; 31: 356-66.
21. Bishop TF, Federman AD, Keyhani S. Physicians’ views on defensive medicine: a national survey. Arch Intern Med 2010; 170: 1081-3.
22. Ozata M, Ozer K, Akkoca Y. Investigation of defensive medical applications of doctors who work in Konya city center. Gumushane Uni Saglık Bil Derg 2018; 7: 132-9.
23. Ali AA, Hummeida ME, Elhassan YAM, Nabag WOM, Ahmed MAA, Adam GK. Concept of defensive medicine and litigation among Sudanese doctors working in obstetrics and gynecology. BMC Medical Ethics 2016; 17: 1-5.
24. Gocen O, Yilmaz A, Aslanhan H, Celepkolu T, Tuncay S, Dirican E. Assistant physicians knowledge and attitudes about defensive medical practices, work-related stress and burnout levels. Turk J Fam Med Primary Care 2018; 12: 77- 87.
25. Baser A, Kolcu G, Cigirgil Y, Kadinkiz B, Ongel K. Evaluation of the opinions of family doctors working in Izmir Karsiyaka district on defensive medical practices. Smyrna Tip Derg 2014; 4: 16-24.
26. Baser A, Kolcu MIB, Kolcu G, Balci UG. Validity and reliability of the Turkish version of the defensive medicine behaviour scale: preliminary study. Tepecik Egit Hast Derg 2014; 24: 99-102.
27. Ozata M, Terlemez A, Ozer K, Akkoca Y. Defensive dentistry: the example of Konya, 2019; 4: 179-88.
28. Solaroglu I, Izci Y, Yeter HG, Metin MM, Keles GE. Health transformation project and defensive medicine practice among neurosurgeons in Turkey. PLoS One 2014; 9: 1-7.
29. Akinci SB, Saricaoglu F, Erden IA, Koseoglu A, Aypar U. Anesteziyologlarda defansif tıp uygulamalarının arastirilmasi. Anestezi Derg 2013; 21: 151-6.
30. Ortashi O, Virdee J, Hassan R, Mutrynowski T, Abu-Zidan, F. The practice of defensive medicine among hospital doctors in the United Kingdom. BMC Med Ethics 2013; 14: 1-6.
31. Mete B, Nacar E, Tekin C, Unver E, Gunes G. Investigating the defensive medical practices of the physicians working in the city center of Malatya. Medicine Sci Int Med J 2017; 6: 270-5.
32. Asher E, Greenberg-Dotan S, Halevy J, Glick S, Reuveni H. Defensive medicine in Israel-a nationwide survey. Plos One 2012; 7: 1-7.
33. Bernstein J. Malpractice: problems and solutions. Clin Orthop Relat Res 2013; 471: 715-20.
34. Yavuz I, Camsari UM, Arisoy Y. The impact of healthcare reform program on post-gradate-training preferences in Turkey. Turkiye Klinikleri J Med Sci 2017; 37: 53-60.