Hekimlerin, Defansif Tıp Uygulamaları Hakkındaki Bilgi ve Tutumları, İşe Bağlı Gerginlik ve Tükenmişlik Düzeyleri

Abstract

Introduction: Defensive medicine is the practice of physicians to use the unnecessary procedures for diagnosis and treatment in order to protect themselves against medical malpractice cases, or to avoid taking the responsibility of high-risk medical practices which are likely to result in a malpractice case. The present study was carried out to reveal the knowledge and attitudes of research assistants working in internal and surgical medical sciences at Dicle University Medical Faculty Hospital about the defensive medicine applications and the factors affecting work-related stress and burnout levels. Method: The sample of this descriptive-cross-sectional type of study was designed by proportional layer method. The questionnaire, which included the sociodemographic data form, the defensive medicine applications attitude scale and the maslach burnout ınventory, was applied to 200 physicians. Results: Of all the participants whose mean age was 29.4±3.0, 70.5%(n=141) were male, 56%(n=112) were married. The frequency of positive and negative defensive medicine was found as 98%(n=196) and 92 % (n=184) respectively. The points of defensive medicine were significantly high in the males, those working at surgical departments, those in the first two years of the specialist training in medicine, those the malpractice case opened about and smokers. The level of work-related tension was significantly high in the ones working at surgical departments, ones who keep watch for eight times or more per month, those the malpractice case opened about, smokers and alcohol users. The average points which the physicians took from Maslach Burnout Inventory were determined as 31.57±11.67 for emotional exhaustion, 11.75±6.49 for desensitization and 29.46±7.72 for personal accomplishment. Conclusion: In our study, it was concluded that most of the research assistants were not satisfied with the choice of profession and specialty, their knowledge of defensive medicine concept was inadequate and their high burnout rates were found in all burnout dimensions. It was seen that the burnout levels of those who applied more to defensive medicine were higher.

Defensive Medicine Practices: Scale Development and Validation

“…The items within positive defensive medicine include “asking for more tests than necessary,”“asking for more screenings than necessary,”“hospitalizing patients without indications,”“asking for unnecessary consultations,”“performing invasive procedures without necessity (e.g., biopsy),” and “prescribing unnecessary medication to the patient.” All items were given within the scope of positive defensive medicine in the literature. 17,21,23,24,34-37 Items such as caring about patient consent, keeping detailed patient records, and making detailed explanations to the patient included in positive defensive medicine in the existing literature constituted a different dimension in the scale developed in the study following the exploratory factor analysis. For this reason, the items were excluded from the scale.…”

“…The dimension concerning negative defensive medicine includes items such as “avoiding treating risky patients,”“taking the initiative less frequently,”“referring the patient,” and “avoiding new treatment methods.” The items concerning negative defensive medicine were also mentioned in many studies within the existing literature. 17,21,24,38,39 At the end of the analysis, the item concerning the preference for ordinary treatment methods under the factor of negative defensive medicine was excluded as its factor loading was low.…”

“…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…”

Medical residents are facing burnout, who are at stake? A cross-sectional study in three university hospitals in Istanbul

“…In another study from a Teaching and Training Hospital pointed out the years in residency as an important factor (9). A study from a different university hospital endorsed the effects of the number of night shifts and years in residency (10). The aim of our study is to evaluate the burnout level among the medical residents in three tertiary care hospitals and to identify the relationship between socio-demographic and occupational factors with burnout level.…”

“…Although some studies on Turkish residents show significant differences only in the Emotional Exhaustion subscale (7,17), others show significance in other subscales too (16). However, the residents from surgical specialties usually face burnout more than other specialties since residents from surgical specialties experience heavier workload, higher risk, higher stress, and fatigue (17), and also, they spend more time in the operation room instead of having face-to-face conversations (10). Depersonalization significantly increases with the increase of years in residency.…”