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Background Defensive medicine is physicians’ deviation from standard medical care which is primarily intended either to reduce or avoid medico legal litigation. Although the Federal Ethics Committee review in Ethiopia has shown that applications for medical/surgical error investigation claims are increasing at an alarming rate, there is no study to date done to estimate the degree of defensive practice done by the physicians with an intention of avoiding this increasing legal claim. This study assessed the practice of defensive medicine among highly litigious disciplines (surgery) and described factors associated with its practice. Methods Cross sectional quantitative study using online survey questionnaires was conducted to assess the degree of defensive practice and six factors (age, years of experience, specialty, monthly income, place of practice and previous medico legal history) associated with its practice were assessed among surgeons working in Ethiopia. Results A total of 430 surgeons directly received an online survey questionnaire and 236 of them successfully completed the questionnaire making the response rate 51.2%. Nearly half of the study participants (51.7%) were aware of the concept of defensive medicine and 174 (74%) reported performing one form of defensive practice. Twenty-nine (12.3%) of the participants have legal dispute history, though only 1.3% of them ended up in penalty. Avoiding high risk procedures was the commonest defensive act performed by 60% of the participants, followed by ordering tests unnecessarily (52.1%). Multinomial logistic regression model showed that there was no association between age of the participant, place of practice, year of experience and defensive practice. This model also showed that cardiothoracic and vascular surgeons perform less defensively than surgeons with other specialty with P value of 0.02. Conclusion The practice of defensive medicine is widespread among surveyed Ethiopian surgeons and further studies are required to objectively estimate the effect of defensive practice on the health care system of the country. Policy makers need to develop strategy towards decreasing this high rate of defensive practice.
Background Defensive medicine is physicians’ deviation from standard medical care which is primarily intended either to reduce or avoid medico legal litigation. Although the Federal Ethics Committee review in Ethiopia has shown that applications for medical/surgical error investigation claims are increasing at an alarming rate, there is no study to date done to estimate the degree of defensive practice done by the physicians with an intention of avoiding this increasing legal claim. This study assessed the practice of defensive medicine among highly litigious disciplines (surgery) and described factors associated with its practice. Methods Cross sectional quantitative study using online survey questionnaires was conducted to assess the degree of defensive practice and six factors (age, years of experience, specialty, monthly income, place of practice and previous medico legal history) associated with its practice were assessed among surgeons working in Ethiopia. Results A total of 430 surgeons directly received an online survey questionnaire and 236 of them successfully completed the questionnaire making the response rate 51.2%. Nearly half of the study participants (51.7%) were aware of the concept of defensive medicine and 174 (74%) reported performing one form of defensive practice. Twenty-nine (12.3%) of the participants have legal dispute history, though only 1.3% of them ended up in penalty. Avoiding high risk procedures was the commonest defensive act performed by 60% of the participants, followed by ordering tests unnecessarily (52.1%). Multinomial logistic regression model showed that there was no association between age of the participant, place of practice, year of experience and defensive practice. This model also showed that cardiothoracic and vascular surgeons perform less defensively than surgeons with other specialty with P value of 0.02. Conclusion The practice of defensive medicine is widespread among surveyed Ethiopian surgeons and further studies are required to objectively estimate the effect of defensive practice on the health care system of the country. Policy makers need to develop strategy towards decreasing this high rate of defensive practice.
Introduction: Treatment failure and claims against physicians may have many negative consequences. Orthopedic surgeons have always been among the most used specialists. Therefore, the investigation of causes and the process of these claims can help reduce the negative effects of medical malpractice on physicians and society. Materials and methods: This retrospective study investigated all medical orthopedic negligence cases in Sari, Iran, from March 2015 to March 2020. Data were collected using a researcher-made checklist and analyzed in SPSS software (V-21). Results: Out of 57 finalized cases investigated in this study, surgeons were found liable in 23 (40%) cases. The mean ± SD age of patients was 41 ± 19.3. Moreover, the level of education had a positive correlation with the surgeon’s liability. The most common cause of complaint was reduced Range of motion (ROM) and the most common type of complained surgery was “open reduction & internal fixation” (ORIF). None of the surgeons were found liable due to surgical site infection or device failure. The mean ± SD time for the file processing was 11.1 ± 10.1 months. The mean indemnity payment was 320 million Iranian Rials (9.7% of indemnity for death in Iran). Conclusion: The most effective way to reduce medical complaint cases is to increase the knowledge and skill levels of physicians. The lack of a blinded arbitration system in both organizations could lead to bias in the case assessment process. Moreover, considering the long processing time of the claims, it is recommended that new technologies should be used to reduce the time and increase the accuracy of the final verdict. The absence of a ‘no-fault’ compensation program is a significant flaw in Iran violating patients’ rights. Also, more studies are needed to evaluate justice and equality in Iranian medical commissions.
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