Defensive Medicine in the Management of Cesarean Delivery: A Survey among Italian Physicians

Abstract

Background and Objectives: This study aims to contribute to the definition of the defensive medicine phenomenon between obstetricians and gynecologists, as well as to possible effects on the frequency of deliveries performed by cesarean sections (CS). Materials and Methods: a digital questionnaire was administered through a mail-list including 600 gynecological specialists (of these 168 doctors completed the test), both in public and private settings. It was made of twenty multiple choice questions, concerning their awareness about the practice of defensive medicine and the planning and execution of CS. All doctors involved received clear and complete information about the purpose of this study and about the organizations that received their answers. Analyses of variance and regression were performed to describe differences between groups and to estimate the relationships between variables. The value of p < 0.5 was considered statistically relevant. Results: our analysis revealed that most respondents are confident with the defensive medicine definition and characteristics. This survey confirmed that gynecologists fear legal actions promoted by their patients and therefore modulate their choices by implementing professional behaviors of so-called “defensive medicine”. This relates to a greater number of medical liability judgements, which more often concern omission or delayed execution of cesarean section, rather than unskillful surgical procedures. Conclusions: there are few data to support a relation between the high rate of CS and defensive medicine. Numerous scientific studies associated this CS rate with the phenomenon of defensive medicine. This practice is constantly growing in all medical areas, especially in high-risk specialties such as obstetrics and gynecology. Our study highlights physicians’ awareness of adopting defensive medicine behaviors in their clinical practice, affecting the choice of the type of delivery to be performed.

Proactive Risk Assessment Through Failure Mode and Effect Analysis (FMEA) for Haemodialysis Facilities: A Pilot Project

“…In this way, the multidisciplinary working group shall enact all the possible directions in order to have the staff and patients informed about the risks and, especially, how to avoid them, with a prophylactic aim. It should be underlined that, recently, legislation changes in Italy have made medical malpractice suits easier to be submitted, hence the huge amount of litigations and costs related to the so-called defensive medicine ( 33 , 34 ). Furthermore, any tool aimed at anticipating potential claims should be thoroughly considered and implemented, when adequate ( 35 , 36 ).…”

When COVID-19 Is Not All: Femicide Conducted by a Murderer with a Narcissistic Personality “Masked” by a Brief Psychotic Disorder, with a Mini-Review

“…Discerning forensics from health cases represents an important issue of risk management. This allows for the avoidance of the consumption of economic and professional resources, available for patients, avoids unnecessary risks for healthcare personnel, and reduces the impact of defensive medicine on clinical outcomes [ 37 , 38 , 39 , 40 ].…”

Policy responses from countries with the highest number of COVID-19 deaths in the world: a scoping review

“…Thirteen addressed the prevention of COVID-19 infection, two addressed management, one addressed diagnostic, one addressed prevention and management, and one addressed diagnostics, treatment and prevention. Most of the health service publications were from Italy, and the most common field of medicine was oncology (Akladios et al, 2020;Barbareschi et al, 2020;Donders et al, 2020;SFSCMFCO, 2020;Kennedy et al, 2020;Fineschi et al, 2020;Coimbra et al, 2020;Boldrini et al, 2020;Fakhry et al, 2020;Sorbello et al, 2020;Van de Voorde et al, 2020;Choi et al, 2020;Starace & Ferrara, 2020;Rubin et al, 2020;Schultz et al, 2020;Rascado Sedes et al, 2020;Davanzo et al, 2020;Indini et al, 2020). The complete list of these documents, with aim, date of publication, country and major measures, is presented in supplementary material (Table S4).…”

“…These publications focused more on COVID-19 preventive measures rather than treatments, this can be explained both by the concern about the high transmissibility capacity of the virus, and by the scarcity of concluded studies on treatment possibilities and diagnostic tests, as it is a new disease with a different profile to previous virus outbreaks (Akladios et al, 2020;Barbareschi et al, 2020;SFSCMFCO, 2020;Kennedy et al, 2020;Fineschi et al, 2020;Coimbra et al, 2020;Boldrini et al, 2020;Fakhry et al, 2020;Choi et al, 2020;Starace & Ferrara, 2020;Schultz et al, 2020;Davanzo et al, 2020;Indini et al, 2020;WHO, 2020b).…”

“…Following the COVID-19 outbreak in Europe, Italy was among the first affected countries, which may explain why the highest number of publications were from this country. In addition, the largest number of publications were in the field of oncology (Akladios et al, 2020;Barbareschi et al, 2020;Fineschi et al, 2020;Boldrini et al, 2020;Fakhry et al, 2020;Sorbello et al, 2020;Van de Voorde et al, 2020;Starace & Ferrara, 2020;Davanzo et al, 2020;Indini et al, 2020).This may be explained by the fact that cancer patients are one of the main risk groups in respect of increased mortality due to COVID-19. Health professional associations play an important role in advancing the quality of health care, developing documents that shape clinical practice, and the dissemination of information, especially during a pandemic, in which many medical services have been postponed or reduced to address only urgent cases (Lv et al, 2020;WHO, 2020b).…”