Internal Medicine Residents and the Practice of Defensive Medicine: A Pilot Study Across Three Internal Medicine Residency Programs

Abstract

Background Defensive medicine is becoming increasingly prevalent in the United States and is estimated to cost billions of dollars in excess healthcare spending. There is evidence that the practice of defensive medicine starts early in the medical career. Defensive medicine has been investigated among residents in high medico-legal risk specialties, but there is a paucity of information on its prevalence among internal medicine residents. Objective To examine the prevalence and patterns of defensive medical practices among internal medicine residents. Methods We conducted an online survey among the residents of three internal medicine residency programs in the 2018-2019 academic cycle. We invited all internal medicine residents within the selected programs to participate through email and asked them to complete an electronic survey assessing defensive medical practices. Results A total of 49 out of 143 residents participated in the study (response rate: 34.3%); 55% (n = 27) of the residents who participated considered the risk of being sued during residency to be low, compared to 40.8% (n = 20) who considered it to be moderate and 4.1% (n = 2) who considered it to be high. Defensive medical practices were found to be widely prevalent (40.0-91.3%) among internal medicine residents across all three clinical training stages. Assurance defensive practices were more common than avoidance practices. Conclusion Defensive medical practices, especially of the assurance type, were widely prevalent among our sample of internal medicine residents.

The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review

“…Table 1 showed the characteristics of the 27 studies involved in the review [ 2 , 12 , 14 , 15 , 17 – 23 , 27 – 42 ]. The included studies were published between 2002 and 2020 and distributed as follows: six in the USA [ 14 , 19 , 29 , 32 , 37 , 42 ], four in Italy [ 12 , 30 , 34 , 35 ], three in Israel [ 22 , 23 , 28 ], two studies per country, China [ 15 , 33 ],Turkey [ 2 , 21 ], Netherlands [ 38 , 41 ], UK [ 27 , 31 ],one study per country, Iran [ 17 ], Sudan [ 20 ], Japan [ 18 ]. Three studies were conducted as an international, the first in Canada, South Africa, and the USA [ 36 ], the second in nine countries in the Middle East [ 40 ], the third in 74 countries [ 39 ].…”

“…Seven studies involved more than 1000 physicians [ 12 , 15 , 29 , 32 , 35 – 37 ]. The studies conducted among different disciplines and distributed as follows: five among neurosurgeons [ 21 , 29 , 36 – 38 ], three among psychiatrists [ 22 , 27 , 40 ], two studies for each specialty, Gastroenterologists [ 18 , 30 ], Obstetrics/Gynecology [ 15 , 20 ], nine studies among General practitioners or more than one specialty [ 2 , 12 , 14 , 17 , 28 , 31 , 33 , 35 , 41 ], and one study for each specialty, Orthopedic [ 32 ], Radiation oncology [ 34 ], Breast pathologists [ 19 ], Plastic and Aesthetic Surgery [ 23 ], Infectious diseases and Clinical microbiology doctors [ 39 ], Internal Medicine [ 42 ].…”

Defensive pharmacy practice: a gap in our understanding

“…However, it may be hypothesised that drivers are similar to those identified in the literature among other health professionals. Influences identified in the literature include risk of litigation, peer pressure, education by senior colleagues, practice norms, pressure by patients and pressure from regulatory bodies [3,5,[10][11][12]. It is possible that the drivers of defensive practice are context-and setting-specific in pharmacy, particularly as it is a profession which encompasses several different areas of practice.…”

“…avoiding a particular field of work or avoiding certain patients identified as high-risk. Defensive practice has a number of negative consequences; it can lead to increased healthcare spending, reduced quality of care to patients and reduced job satisfaction among practitioners [ 2 , 3 ].…”