ArticleBMJ open2019
Triggers of defensive medical behaviours: a cross-sectional study among physicians in the Netherlands.
Article in BMJ open, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 22 citations in OpenAlex.
- Defensive medicine practices and attitudes toward malpractice among physicians in Jordan: a cross-sectional study.BMC health services research · 2026Article
- Evaluating Alleged Malpractice Cases Against Cardiologists and Cardiothoracic Surgeons in The Netherlands.Interdisciplinary cardiovascular and thoracic surgery · 2026Article
- The Mediating Role of Working Hours in the Effect of Surgical and Internal Medicine Residents' Fear of Malpractice on Defensive Medical Practices.The Eurasian journal of medicine · 2026Article
- Prevalence of defensive medicine behaviors, associated risk factors and its mitigation strategies among physicians in Gaza Strip, palestine: a mixed method study.BMC medical ethics · 2025Article
- The Chinese version of Defensive Medicine Scale (DMS): reliability and validity test among physicians.BMC psychology · 2024Article
- The effects of loving-kindness meditation on doctors' communication anxiety, trust, calling and defensive medicine practice.BioPsychoSocial medicine · 2024Article
- Policy Options for Reducing Defensive Medicine Behaviors: A Multi-Method Study.Medical journal of the Islamic Republic of Iran · 2024Article
- Experience of obstetricians and gynecologists in the management of medicolegal cases in Egypt.BMC women's health · 2022Article
- The occurrence, types, reasons, and mitigation strategies of defensive medicine among physicians: a scoping review.BMC health services research · 2022Article
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Authors and funding
4 authors at 2 institutions in 1 country.
Funding
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Abstract
objectivesThis study investigated whether the attitudes of physicians towards justified and unjustified litigation, and their perception of patient pressure in demanding care, influence their use of defensive medical behaviours.
designCross-sectional survey using exploratory factor analysis was conducted to determine litigation attitude and perceived patient pressure factors. Regression analyses were used to regress these factors on to the ordering of extra tests or procedures (defensive assurance behaviour) or the avoidance of high-risk patients or procedures (defensive avoidance behaviour).
settingData were collected from eight Dutch hospitals.
participantsRespondents were 160 physicians and 54 residents (response rate 25%) of the hospital departments of (1) anaesthesiology, (2) colon, stomach and liver diseases, (3) gynaecology, (4) internal medicine, (5) neurology and (6) surgery. PRIMARY OUTCOME MEASURES: Respondents' application of defensive assurance and avoidance behaviours.
results'Disapproval of justified litigation' and 'Concerns about unjustified litigation' were positively related to both assurance (β=0.21, p<0.01, and β=0.28, p<0.001, respectively) and avoidance (β=0.16, p<0.05, and β=0.18, p<0.05, respectively) behaviours. 'Self-blame for justified litigation' was not significantly related to both defensive behaviours. Perceived patient pressures to refer (β=0.18, p<0.05) and to prescribe medicine (β=0.23, p<0.01) had direct positive relationships with assurance behaviour, whereas perceived patient pressure to prescribe medicine was also positively related to avoidance behaviour (β=0.14, p<0.05). No difference was found between physicians and residents in their defensive medical behaviour.
conclusionsPhysicians adopted more defensive medical behaviours if they had stronger thoughts and emotions towards (un)justified litigation. Further, physicians should be aware that perceived patient pressure for care can lead to them adopting defensive behaviours that negatively affects the quality and safety of patient care.
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