The perceived impact of defensive medicine on medical practice

Introduction. Defensive medicine can be defined as the modification of practice in response to fear of litigation. Aim. Study the felt impact of defensive medicine on the practice of French general practitioners. Design. Cross-sectional descriptive quantitative study carried out between January and March 2020 by two investigators with 185 general practitioners (GPs) randomly drawn from listed GPs of Gironde. This study follows a first focus group study that enabled the development of a 20-item survey distributed by telephone and secondarily anonymized. Results. A total of 132 GPs completed the survey (74.5% response rate). 34.8 % of respondents declared a previous malpratice liability. When under forensic pressure, nearly all of respondents (98.5%) said they had changed at least one aspect of their practice: 80.3% changed their note-taking, 60.6% ordered more imaging exams, 57.8 % more biology, 34.9% changed their drug prescriptions. The main avoidance behaviors consisted in referring the patient more easily to a specialist colleague or to the emergency department (73.5% and 27.3% of respondents respectively) and for 54.4% of them to give up the practice of technical acts deemed to be at risk. Physicians' self-rated feelings regarding the impact of defensive medicine in their practice averaged 4.58 out of 10. A history of litigation was not significantly associated with a change in defensive behavior. Protective behaviors were spontaneously implemented to fight against the pressure: 74.2% debriefed the difficult consultation with a colleague, 72.7 % gave more explanations to the patient. Conclusion. The concept of defensive medicine is of interest to general practitioners. All of them seemed to be affected in their practice, but to varying degrees. Work on the patient/doctor relationship could prevent the development of these behaviors.