Table 2 Characteristics and types of defensive medicine behaviors reported in the included studies

Assurance behaviors (not detrimental to patients)

• Prescribe unnecessary services

• Prescribing unnecessary medication or antibiotics’

• Request unnecessary laboratory tests and investigations

• Request unnecessary imaging

• Calling unnecessary examinations and consultations

• Ordering more consultations on probable complications

• Selecting the more extremist diagnosis for borderline cases

• Unnecessary referral cases to other specialties and hospitals

• Refer patients to other specialists unnecessarily

• Send patients to emergency room, in unnecessary conditions

• Unnecessary cases admission and hospitalization

• Hospitalized patient who can be treated as an outpatient

• Suggest and perform unnecessary invasive procedures

• Ordering unnecessary biopsies

• Ordering unnecessary endoscopies

• Spend more time with patients and their family

• Describe medical procedures to patients in more details

• Request additional reviews

• Increases follow-up

• Initiates communication with family

• More patients’ observations than required

Avoidance behaviors (detrimental to patients)

• Avoid applying effective high-risk procedures / interventions, and use non-invasive protocols

• Ceasing high-risk procedures

• Avoid treatment protocols or guidelines with high complication

• Avoiding to admit and care high-risk patients

• Withdraw from practice entirely and retire

• Avoid patients with complex medical problems

• Performed unnecessary intervention surgery

• Perform cardio-pulmonary resuscitations and intubations for poor prognosis patients

• Caesarean section without indications

• Excising skin lesions that are not suspected of being malignant

• Avoiding switching to oral treatments

• Avoid stop parenteral drugs