SynthesisBMJ open2024
Defensive healthcare practice: systematic review of qualitative evidence.
Synthesis in BMJ open, 2024. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
What it found
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed.
- Title Medico-Legal Preparedness in Dental Education: Training Gaps, Defensive Practice and Curriculum Implications Among Romanian Dental Students and Dentists.Dentistry journal · 2026Article
- Anticipated online harassment and potential chilling effects on mandatory child abuse reporting: A pilot survey of pediatricians in Japan.PCN reports : psychiatry and clinical neurosciences · 2026Article
- Workload generated by external consults in an Irish tertiary vascular centre.Irish journal of medical science · 2026Article
- When Doing Nothing Feels Safer: A Multilevel Framework for Therapeutic Inertia in Psychiatry.Healthcare (Basel, Switzerland) · 2026Review
- The impact of patient death and suicide on mental health professionals: mixed-methods study.BJPsych open · 2026Article
- Defensive Medical Practice in Dentistry: A Dual-Perspective Cross-Sectional Analysis of Dentists and Patients in Romania.Healthcare (Basel, Switzerland) · 2026Article
- Defensive medicine practices and attitudes toward malpractice among physicians in Jordan: a cross-sectional study.BMC health services research · 2026Article
- Cultural and Structural Influences on Shared Decision-Making in the Care of Critically Ill Patients with Stroke in China: A Critical Realist Qualitative Study.Neurocritical care · 2026Article
- Great debate: the new risk factor-weighted clinical likelihood model is useful to estimate the initial pre-test probability of obstructive coronary artery disease in individuals with suspected chronic coronary syndromes.European heart journal · 2026Article
- Nursing management decisions in fever: a mixed-methods approach to understanding.International journal of nursing studies advances · 2026Article
- Hospital Culture: Defensive Medicine as Perceived by Medical Students: A Qualitative Study.Deutsches Arzteblatt international · 2026Article
- Exploring nurses' documentation prioritization strategies to alleviate EHR documentation burden: a phenomenological study.JAMIA open · 2026Article
- Comfort or necessity: obstetricians' perspectives on the drivers, consequences, and recommendations for reducing caesarean section rates in Turkey.BMC pregnancy and childbirth · 2026Article
- Ethical behavior profiles among nursing interns and their determinants: a latent profile analysis.BMC medical education · 2026Article
- Toward Safer Diagnoses: A SEIPS-Based Narrative Review of Diagnostic Errors.Diagnostics (Basel, Switzerland) · 2026Review
- Construction and validation of nomogram model for high-risk early warning of medical complaints based on occupational characteristics and workload of medical staff.Frontiers in public health · 2026Article
- Antimicrobial stewardship in neonatal intensive care units in resource-limited regions of China: a protocol for a multicenter, before-and-after, interrupted time series quality improvement study.Frontiers in public health · 2026Article
- The Iran Healthcare Professionals' Charter of Rights.Archives of Iranian medicine · 2026Article
- A balancing act: Primary care midwives screening for fetal growth restriction- a focus group study.International journal of nursing studies advances · 2025Article
- Analysis of the causes of improper medical decision-making in medical damage liability disputes in China: a text mining approach.BMC health services research · 2025Article
Corrections and comments
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Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
objectiveTo synthesise qualitative evidence on clinicians' views and experiences of defensive practice.
designSystematic review of qualitative data. DATA SOURCES: MEDLINE, Embase, PsycINFO, AMED, Maternity and Infant Care, CINAHL, ASSIA, Sociological Abstracts, Proquest Dissertations & Theses and PROSPERO were searched from 2000 to October 2023. ELIGIBILITY CRITERIA: We included English-language studies of clinicians which reported qualitative data on the impact of litigation or complaints on clinical practice. DATA EXTRACTION AND SYNTHESIS: We coded findings data line by line using a grounded theory approach. We assessed quality using Hawker
results17 studies were included. Participants identify a range of clinical decisions which may be defensively motivated, relating to diagnosis and documentation as well as to treatment. Defensive practice often relates to a diffuse sense of risk rather than the direct threat of litigation and may overlap with other motivations, such as perceived pressure from patients or the desire to avoid harm. Defensive practice is seen to be harmful in many ways, but again, these perceptions may gain force from broader narratives of mistrust and disempowerment, as much as from the risk of litigation.
conclusionsThe idea of defensive practice, as enacted, is more complex than some theoretical accounts suggest and may often function to express broader concerns about the work of clinical care. The qualitative evidence calls into question the view of defensive practice as a key mediator linking litigation risk to inappropriate treatment and excess costs.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.