Table 3 Reasons for practicing defensive medicine and strategies to reduce defensive medicine reported in the included studies
Reasons for practicing DM | Possible solutions and strategies to reduce DM | ||
|---|---|---|---|
Main themes | Codes | Main themes | Codes |
Patient-related reasons | • Increasing number of lawsuits against physicians • Physicians’ self-perceived threats from patients • Past disputes with patients • Avoid potential conflict with patients • Patient pressure factors | Structured training and education | • Improve Physicians training educating and about appropriate care in clinical surroundings • Implementation of awareness programs about the DM phenomenon • Establish and disseminate clinical protocols or guidelines targeting widespread DM actions • Support the regular use of evidence-based medicine and structured care • More training in problem-solving techniques • Health curriculum should specifically address litigation issues |
Organization-related reasons | • Increasing malpractice premiums • Decreasing provider reimbursement • Inadequate medical and or organizational procedures • Inadequate malpractice and liability coverage • Inadequate hospital support for liability issues • Inadequate legislation protecting doctors | Physician–patient relationship | • Restore trust in physician -patient relationships • Innovate harmony and alliance between physician and patient • More communication with patients and their families • Induct social workers to participate in managing the conflict between physicians and patients • Promoting the ethical values of physicians |
Physician-related reasons | • Solo practice • Previous experience of complaints and legal claim for themselves and colleagues • A perceived legal risk • Fear and concerns over medical liability • Physicians Low-income • Concerns about financial and possible legal consequences • Lack of self-confidence • Lack of specialized knowledge • The weekly activity volume • Ineffective physician–patient relationship • Legal protection • Feared compromising their professional reputation and or career | Reform of the health system | • Redistribution of the health procedures between various healthcare professionals, and enhance multidisciplinary collaborations • A comprehensive examination of main factors and the expenditure on DM, and a better understanding of the current shortages in the healthcare system • Establish clinical records management • Better use of the risk management techniques • Establish clinical auditing system and health debriefing • Physician reward system reform • Forming a committee to study malpractice cases to avoid recurrence • Performing a compensation procedure for a patient who has suffered a medical injury |
Society-related reasons | • Concerns about media attention • Believe in working in a blame-free culture • A general negative context surrounding negligence claims against physicians | Reform the liability system | • Ways of complaints and inquiry should be upgraded. • Introduce complaints committee in hospitals • Filtration of cases at an early stage to prevent the court as much as possible • Establish alternatives to the existing litigation system • Establishment of health courts and specialized courts with trained judges in the field of health care |