Defensive medicine in the emergency department. The clinicians’ perspective

Cervellin, Gianfranco; Cavazza, Mario

doi:10.4081/ecj.2016.5615

Cited by 7 publications

(4 citation statements)

References 21 publications

(22 reference statements)

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“…EDs are units that represent the first point of presentation for high-risk patients and that exhibit high patient turnover. ED physicians may, therefore, request more tests than necessary and seek to share risks with other clinics (19). In addition to the high density of risky patients in EDs and the stress in the working environment, emergency physicians also experience problems with professional colleagues; much time is lost due to procedures such as requesting consultations by telephone and convincing colleagues to perform them and admission or referral procedures.…”

Section: Discussionmentioning

confidence: 99%

Defensive Medicine in the Emergency Department: A Cross-sectional Study from the Perspective of Emergency Medical Specialists

Delice¹,

Tekin²,

Yılmaz³

2019

Eurasian J Emerg Med

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Section: Discussionmentioning

confidence: 99%

Defensive Medicine in the Emergency Department: A Cross-sectional Study from the Perspective of Emergency Medical Specialists

Delice¹,

Tekin²,

Yılmaz³

2019

Eurasian J Emerg Med

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“…Defensive medicine is undoubtedly one of such issues, since the emergency settings are particularly plagued by malpractice and liability, 21 thus leading the way to an inappropriate utilization of laboratory resources. 22 This unjustified practice carries several risks, such as the possible generation of false positive results, the disruption of laboratory organization and ultimate waste of human and economic healthcare resources.…”

Section: Discussionmentioning

confidence: 99%

Attitudes and beliefs of emergency physicians on lab tests utilization in clinical practice. A multicenter survey

Saccenti¹,

Lunian²,

Montagnana

et al. 2019

Emerg Care J

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It is commonly perceived that the main obstacle for an effective partnership between Emergency Medicine (EM) and Laboratory Medicine (LM) is the lack of reciprocal knowledge and understanding. A further aspect is a partial comprehension of clinical significance and implications of some tests. The real scenario of attitudes and beliefs of Emergency Physicians (EPs) on lab tests utilization in clinical practice remains largely unclear. Therefore, this original study was designed to explore this field of medical knowledge, by using a survey on attitudes and beliefs in laboratory diagnostics which was disseminated among many Italian EPs. A questionnaire containing 20 different items/statements was designed and then disseminated either directly, or in a digital format. Overall, 183 questionnaires were compiled and collected. The results of this nationwide survey seem to confirm the existence of a suboptimal knowledge of both clinical and economic impact of urgent laboratory tests by Italian EPs. An unsatisfactory relationship between EPs and laboratory professionals seems also to emerge. Several EPs attribute this to Shortage of time to think (18.6%), followed by Fair of medical-legal litigation (13.6%). On the other hand, interestingly, it also emerged that some Italian hospitals still include obsolete o redundant tests in panels of urgent laboratory analyses, potentially misleading for the diagnostic reasoning in the Emergency Department (ED). In conclusion, the virtuous circle between EM and LM should be further reinforced for optimizing clinical pathways in Italian EDs, improving clinical outcomes and reducing unnecessary expenditures. A major agreement between laboratory and emergency professionals

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“…13,14 Positive defensive medicine includes providing excessive services, providing low marginal or medical benefits, and not being cost-effective. Some examples of this include ordering more tests, 15 screenings, 16 and consultations 17 than necessary; hospitalizing a patient without any indication of there being something wrong 18 ; keeping detailed medical records 19 ; explaining the medical procedures and the patient's condition in a very detailed manner 20 ; spending more time with the patients 21 ; suggesting invasive procedures 22 ; and making frequent rounds. 15 Negative defensive medicine produces fewer effects on cost, but it results in insufficient and substandard services being provided to patients.…”

mentioning

confidence: 99%

Defensive Medicine Practices: Scale Development and Validation

Ünal

Akbolat

2021

Med Decis Making

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Aim Defensive medicine refers to practices with low marginal benefit to patients that doctors may undertake to protect themselves from legal liability. We aimed to develop a scale to measure the practice of defensive medicine. Method We identified aspects of defensive medicine previously reported in the literature and conducted and analyzed semi-structured interviews with 21 physicians in Sakarya to augment and clarify these aspects between May 15, 2018, and June 15, 2018. Informed by these results, we developed, pilot tested, refined, and fielded a 10-item survey to 1724 doctors in Turkey between April 1, 2019, and July 16, 2019. We examined the psychometric properties of the scale using exploratory (EFA) and confirmatory factor analyses (CFA). Results The 10-item scale provided measures of 2 factors: positive defensive medicine (assurance) and negative defensive medicine (avoidance), with Cronbach’s alpha >0.8 for the scale and both subscales in both the EFA and CFA subsamples and excellent goodness-of-fit measures. Conclusions We developed a highly reliable scale to measure positive and negative defensive medicine practice that may be suitable for future research on physician decision making.

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Defensive medicine in the emergency department. The clinicians’ perspective

Abstract: The overuse of medical services is regarded as a growing problem in Western countries, accounting for up to 30% of all delivered care, and carrying a higher risk of morbidity and mortality.

Cited by 7 publications

References 21 publications

Defensive Medicine in the Emergency Department: A Cross-sectional Study from the Perspective of Emergency Medical Specialists

Defensive Medicine in the Emergency Department: A Cross-sectional Study from the Perspective of Emergency Medical Specialists

Attitudes and beliefs of emergency physicians on lab tests utilization in clinical practice. A multicenter survey

Defensive Medicine Practices: Scale Development and Validation

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