Background:
Defensive medicine is defined as a deviation from sound medical practice induced primarily by a threat of liability and is categorized as assurance or avoidance behaviors. Assurance behaviors include the provision of additional services of minimal value with the goal of reducing adverse outcomes. Avoidance behaviors include efforts to avoid providing services or caring for certain patients perceived as high risk. Research shows that defensive medicine is common among practicing physicians, but little is known about trainees’ experience with defensive medicine.
Methods:
We conducted a cross‐sectional survey of all fourth‐year medical students and third‐year residents in medical and surgical specialties at the Northwestern University Feinberg School of Medicine. Respondents were asked to rate how often concerns about malpractice liability caused their teams to engage in 4 types of assurance and 2 types of avoidance behaviors using a 4‐point scale (never, rarely, sometimes, often). Respondents similarly rated how often their attending physicians explicitly recommended that malpractice liability be taken into account during clinical decisions. We collapsed “sometimes” and “often” responses during our analysis as indicative of an affirmative response. We also asked respondents whether their teams had ever chosen not to disclose a medical error resulting in harm and, if so, whether concern about medical liability played a role in the decision.
Results:
Overall, 126 of 194 eligible medical students (65%) and 76 of 141 residents (54%) completed the survey. Among medical students, 94% had experienced 1 or more defensive medical practices, including 92% reporting assurance and 34% reporting avoidance practices. Among residents, 96% had experienced defensive medicine, including 96% reporting assurance and 43% reporting avoidance behavior. Overall, 40% of medical students and 47% of residents reported being explicitly taught to take malpractice concerns into account when making clinical decisions. Among medical students who had witnessed a medical error resulting in harm, 30% reported a failure to disclose, and 63% of those reporting a failure to disclose indicated that malpractice liability concern played a role in the decision. Among residents who had witnessed a medical error resulting in harm, 27% reported a failure to disclose, and 86% of these respondents indicated that malpractice liability played a role in the decision.
Conclusions:
The majority of trainees experienced defensive medicine practices, and many reported being explicitly taught to take malpractice liability into account when making clinical decisions. Moreover, more than a quarter of trainees reported failure to disclose a medical error resulting in harm, and concern over medical liability was cited as a common contributing factor to this decision. Our findings have broad implications for how the informal curriculum influences trainees’ developing practice patterns and disclosure of medical error.
Disclosures:
K. O’Leary ‐ none; J. Choi ‐ none; K. Watson ‐ none; M. Williams ‐ none