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Defensive medicine has two forms: positive (assurance behavior) or negative (avoidance behavior), depending on the clinical situation. Defensive medicine minimizes the risk of litigation and tends to vary between surgical and non-surgical specialties due to the nature of the risks involved and the potential for litigation. This study aimed to investigate the prevalence and patterns of defensive medicine practice among Egyptian physicians, compare surgical versus non-surgical specialties, and examine their correlation with medico-legal complaints and occupational determinants. This cross-sectional study was conducted among physicians from surgical and non-surgical specialties working in different Egyptian hospitals. A self-administered online questionnaire was distributed using the snowball sampling technique. The Defensive Medicine Behavior Scale (DMBS) was used to assess the practice of defensive medicine. A sample of 210 physicians with a mean age of 39 ± 7 years was included; 51.4% held the highest qualification of M.D. or Ph.D., with an equal sex distribution (1:1). There was a high level of defensive medicine practice in both surgical and non-surgical specialties: 41.7% and 39.5%, respectively. However, the difference between the two groups was not statistically significant (P-value >0.05). Regression analysis showed that working at university hospitals and having workplace insurance coverage for medico-legal claims were associated with fewer positive defensive medicine practices. Conversely, concerns about the financial implications of medico-legal claims and negative reactions from patients or families were associated with a greater prevalence of positive defensive medicine practices. Despite the high prevalence of defensive medicine practices, no statistically significant differences were observed between the surgical and non-surgical groups regarding overall engagement in defensive medicine.

Concern over rising healthcare expenditures has led to increased scrutiny of medical practices. As medical liability and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk. High-risk specialties, such as neurosurgery, are particularly affected and neurosurgeons have altered their practices to lessen medical-legal risk. We present the first national survey of American neurosurgeons' perceptions of malpractice liability and defensive medicine practices. A validated, 51-question online-survey was sent to 3344 practicing U.S. neurosurgeon members of the American Association of Neurological Surgeons, which represents 76% of neurosurgeons in academic and private practices. A total of 1028 surveys were completed (31% response rate) by neurosurgeons representing diverse sub-specialty practices. Respondents engaged in defensive medicine practices by ordering additional imaging studies (72%), laboratory tests (67%), referring patients to consultants (66%), or prescribing medications (40%). Malpractice premiums were considered a \"major or extreme\" burden by 64% of respondents which resulted in 45% of respondents eliminating high-risk procedures from their practice due to liability concerns. Concerns and perceptions about medical liability lead practitioners to practice defensive medicine. As a result, diagnostic testing, consultations and imaging studies are ordered to satisfy a perceived legal risk, resulting in higher healthcare expenditures. To minimize malpractice risk, some neurosurgeons have eliminated high-risk procedures. Left unchecked, concerns over medical liability will further defensive medicine practices, limit patient access to care, and increase the cost of healthcare delivery in the United States.

Objective To identify the prevalence of the practice of defensive medicine among Italian hospital physicians, its costs and the reasons for practising defensive medicine and possible solutions to reduce the practice of defensive medicine. Methods Cross-sectional web survey. Main outcome measures Number of physicians reporting having engaged in any defensive medicine behaviour in the previous year. Results A total of 1313 physicians completed the survey. Ninety-five per cent believed that defensive medicine would increase in the near future. The practice of defensive medicine accounted for approximately 10% of total annual Italian national health expenditure. Conclusions Defensive medicine is a significant factor in health care costs without adding any benefit to patients. The economic burden of defensive medicine on health care systems should provide a substantial stimulus for a prompt review of this situation in a time of economic crisis. Malpractice reform, together with a systematic use of evidence-based clinical guidelines, is likely to be the most effective way to reduce defensive medicine.

Introduction There is evidence that burnout rates in doctors are high following the COVID pandemic, but with considerable variation across geographical location and specialty. In 2018, we performed a UK‐wide survey of obstetrics and gynecology (O&G) doctors, providing baseline data on burnout, wellbeing, and defensive medical practice (DMP) directly before the pandemic. This study aims to determine the prevalence of burnout, poor wellbeing, and DMP in obstetricians and gynecologists after the pandemic, to compare these to pre‐pandemic levels, and to explore the relationship between burnout, poor wellbeing, and DMP. Material and Methods This was a repeated national cross‐sectional survey study. Practicing obstetrics and gynecology doctors registered with the Royal College of Obstetricians and Gynaecologists (RCOG) were eligible to participate. In 2022, an email containing a survey link was sent to 7388 UK doctors registered with the RCOG. The same method and measures were used as in our previous 2018 study. Burnout prevalence was assessed using the Maslach Burnout Inventory Human Services Survey for Medical Personnel (MBI). Wellbeing and DMP were assessed using self‐report questionnaires. Results The response rate for the post‐pandemic survey was 19% (1400/7388) and 55% (3102/5661) for the pre‐pandemic survey. A total of 1114 out of 1400 (80%) met the inclusion criteria and completed the MBI. Burnout criteria were met in 72%, compared with 36% before the pandemic (adjusted odds ratio [AOR] 4.7, 95% confidence interval [CI] 4.0 to 5.5). Highest levels were seen in trainees (80%). Thirty‐nine percent of doctors reported DMP compared with 13% pre‐pandemic. Worse doctor wellbeing was reported across all items; 62% of doctors reported anxiety, 31% depression, and 9% suicidal thoughts compared with 33%, 14%, and 3% pre‐pandemic. Burnout was associated with DMP and poor wellbeing, including suicidal thoughts, depression, and anxiety. Conclusions This national study suggests high levels of burnout in obstetricians and gynecologists compared with pre‐pandemic levels, particularly in trainees. There was a probable decline in wellbeing compared with pre‐pandemic levels. Poor wellbeing and DMP were associated with burnout. Burnout interventions to improve doctor wellbeing, quality of care, and patient safety are urgently needed. In this repeated national cross‐sectional survey, we report very high levels of burnout, poor wellbeing, and defensive medical practice across all grades of UK obstetric and gynecology doctors that have risen since before the pandemic.

Background Fear of malpractice can affect the psychological well-being and clinical decision-making processes of surgeons. This study aimed to evaluate fear of malpractice, generalized anxiety levels (GAD-7), and defensive medicine practices among rhinoplasty surgeons in Türkiye. Methods A cross-sectional online survey was conducted among ENT and plastic surgeons performing rhinoplasty between August and September 2025. The survey included the 6-item Fear of Malpractice Scale, Generalized Anxiety Disorder-7 (GAD-7), and the 18-item Defensive Medicine Practices Attitude Scale. Descriptive statistics, correlation analyses, and multiple linear regression were performed. Results A total of 188 surgeons participated. 17% of the participants were female, 83% were male, and their mean age was 40.8 ± 6.7 years. The mean fear of malpractice score was 21.28 ± 6.17 (range 6–30). The mean GAD-7 score was 8.38 ± 4.13 (range 0–21). Female surgeons had higher GAD-7 scores than males (9.84 ± 4.21 vs. 8.06 ± 4.07, p  = 0.038). Fear of malpractice correlated positively with GAD-7 ( r  = 0.34, p  < 0.001) and defensive medicine scores (ρ = 0.32, p  = 0.001). In multivariable regression analysis, higher malpractice fear (β = 0.29, p  < 0.001), younger age (β = -0.11, p  = 0.002), female gender (β = 1.21, p  = 0.031), and working in private institutions (β = 2.46, p  < 0.001) independently predicted higher anxiety levels (adjusted R² = 0.254). Conclusions Fear of malpractice is significantly associated with general anxiety and defensive medical practices among rhinoplasty surgeons. Balanced medico-legal training and institutional support can help reduce unnecessary defensiveness while protecting the patient’s best interests in decision-making.

Abstract Objectives The impact of malpractice concerns on pathologists’ use of defensive medicine and interpretations of melanocytic skin lesions (MSLs) is unknown. Methods A total of 207 pathologists interpreting MSLs responded to a survey about past involvement in malpractice litigation, influence of malpractice concerns on diagnosis, and use of assurance behaviors (defensive medicine) to alleviate malpractice concerns. Assurance behaviors included requesting second opinions, additional slides, additional sampling, and ordering specialized tests. Results Of the pathologists, 27.5% reported that malpractice concerns influenced them toward a more severe MSL diagnosis. Nearly all (95.2%) pathologists reported practicing at least one assurance behavior due to malpractice concerns, and this practice was associated with being influenced toward a more severe MSL diagnosis (odds ratio, 2.72; 95% confidence interval, 1.41-5.26). Conclusions One of four US skin pathologists upgrade MSL diagnosis due to malpractice concerns, and nearly all practice assurance behaviors. Assurance behaviors are associated with rendering a more severe MSL diagnosis.

Background Defensive medicine is defined as a doctor’s deviation from standard practice to reduce or prevent complaints or criticism. The objectives of this study were to assess the prevalence of the practice of defensive medicine in the UK among hospital doctors and the factors affecting it. Methods A quantitative study was designed, with a detailed seventeen point questionnaire. Defensive medicine practice was assessed and tested against four factors age, gender, specialty and grade. Three hundred hospital doctors from three UK hospitals received the questionnaire. Results Two hundred and four (68%) out of 300 hospital doctors responded to the survey. Seventy eight percent reported practicing one form or another of defensive medicine. Ordering unnecessary tests is the commonest form of defensive medicine reported by 59% of the respondents. This is followed by unnecessary referral to other specialties (55%). While only 9% of the sampled doctors would refuse to treat high risk patients, double this number would avoid high risks procedures all together (21%). A linear regression module has shown that only senior grade was associated with less practice of defensive medicine. Conclusion Defensive medical practice is common among the doctors who responded to the survey. Senior grade is associated with less practice of defensive medicine.

BACKGROUND:Defensive medicine is prevalent among US neurosurgeons due to the high risk of malpractice claims. This study provides national estimates of US neurosurgeonsʼ defensive behaviors and perceptions. OBJECTIVE:To examine the relationship of defensive medicine—both “assurance” behaviors and “avoidance” behaviors—to the liability environment. METHODS:A 51-question online survey was sent to 3344 US neurosurgeon members of the American Board of Neurological Surgeons (ABNS). The survey was anonymous and conducted over 6 weeks in the spring of 2011. The previously validated questionnaire contained questions on neurosurgeon, patient, and practice characteristics; perceptions of the liability environment; and defensive-medicine behaviors. Bivariate and multivariate analyses examined the state liability risk environment as a predictor of a neurosurgeonʼs likelihood of practicing defensive medicine. RESULTS:A total of 1026 neurosurgeons completed the survey (31% response rate). Neurosurgeonsʼ perceptions of their stateʼs liability environment generally corresponded well to more objective measures of state-level liability risk because 83% of respondents correctly identified that they were practicing in a high-risk environment. When controlling for surgeon experience, income, high-risk patient load, liability history, and type of patient insurance, neurosurgeons were 50% more likely to practice defensive medicine in high-risk states compared with low-risk-risk states (odds ratio1.5, P < .05). CONCLUSION:Both avoidance and assurance behaviors are prevalent among US neurosurgeons and are correlated with subjective and objective measures of state-level liability risk. Defensive medicine practices do not align with patient-centered care and may contribute to increased inefficiency in an already taxed health care system.

One aim of malpractice reform has been to reduce the practice of defensive medicine. Laws in three states that changed the malpractice standard for emergency care to gross negligence did not substantially influence practice intensity in emergency departments. Defensive medicine is considered by many to be a major source of wasteful medical spending in the United States. A widely cited report estimates that $210 billion is spent annually on needless care motivated by fear of malpractice litigation. 1 Although this estimate may be high, 2 many agree that malpractice reform belongs on the short list of policy options for reducing health care costs. 3 – 6 Physicians themselves report that they are strongly influenced by fear of lawsuits. 7 – 9 There are few data, however, to show whether physicians would practice differently if the risk of legal action were appreciably lowered. To the . . .

ObjectivePsychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists and to understand whether awareness of DP correlated with defensive behaviours.MethodsA questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims.ResultsForty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved in malpractice claims, while 132 (62.1%) participants admitted to practising DP. Residents acknowledged the practice of DP more than did senior psychiatrists (p=0.038).Awareness of DP correlated with unnecessary hospitalisation of suicidal patients, increased unnecessary follow-up visits and prescribing smaller drug dosages than required for pregnant women and elderly patients.ConclusionsThis study provides evidence that DP is well established in the routine clinical daily practice of psychiatrists. Further studies are needed to reveal whether DP effectively protects psychiatrists from malpractice suits or, rather, if it impedes providing quality psychiatric care and represents an economic burden that leads to more harm for the patient.