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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.

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.

The role of defensive medicine in driving up health care costs is hotly contended. Physicians and health policy experts in particular tend to have sharply divergent views on the subject. Physicians argue that defensive medicine is a significant driver of health care cost inflation. Policy analysts, on the other hand, observe that malpractice reform, by itself, will probably not do much to reduce costs. We argue that both answers are incomplete. Ultimately, malpractice reform is a necessary but insufficient component of medical cost containment. The evidence suggests that defensive medicine accounts for a small but non-negligible fraction of health care costs. Yet the traditional medical malpractice reforms that many physicians desire will not assuage the various pressures that lead providers to overprescribe and overtreat. These reforms may, nevertheless, be necessary to persuade physicians to accept necessary changes in their practice patterns as part of the larger changes to the health care payment and delivery systems that cost containment requires.

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.

Concerns about reducing the rate of growth of health expenditures have reignited interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however. This article identifies the various components of liability system costs, generates national estimates for each component, and discusses the level of evidence available to support the estimates. Overall annual medical liability system costs, including defensive medicine, are estimated to be $55.6 billion in 2008 dollars, or 2.4 percent of total health care spending.

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.

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.

Defensive medicine is estimated to cost the United States $210 billion annually. Trauma surgeons are at risk of practicing defensive medicine in the form of reflexively ordering computed tomography (CT) scans. The aim of this study is to quantify the monetary impact and radiation exposure related to the radiographic workup of trauma patients. We conducted a prospective, observational study involving 295 trauma patients at Level I trauma center. Physicians were surveyed regarding specific CT scans ordered, likelihood of significant injuries found on scans, and which scans would have been ordered in a hypothetical, litigation-free environment. Four hundred sixteen of 1,097 CT scans (38%) were ordered out of defensive purposes. Nine CT scans (2.2%) that would not have been ordered resulted in a change in management. Defensively ordered CT scans resulted in nearly $120,000 in excess charges and 8.8 mSv of unnecessary radiation per patient. Defensively ordered CT scan in the workup of trauma patients is a prevalent and costly practice that exposes patients to potentially unnecessary and harmful radiation. •Prospective, observational study characterizing defensive medicine in the workup of trauma patients.•Reflexively ordered CT scans in trauma activation patients are a prevalent and costly practice.•These scans also expose patients to potentially unnecessary and harmful radiation.

Defensive medicine, driven by fear of litigation, increases healthcare costs and physician stress, particularly in high-risk specialties such as surgery. This study investigates the attitudes and practices of faculty members and residents in surgical discipline regarding defensive medicine. In this cross-sectional study, 147 surgeons (faculty, residents, and fellows) from IUMS teaching hospitals completed a validated questionnaire assessing attitudes toward the ethicality of defensive medicine and the prevalence of defensive practices. Data were analyzed using SPSS version 24, applying chi-square tests, independent t-tests, and Mann-Whitney U tests. Nearly half of the participants (48.9%) considered defensive practices ethical. Common defensive behaviors included consultation referrals (47.6%), unnecessary laboratory tests (36.7%), and avoidance of high-risk procedures (44.3%). Key concerns driving defensive practices were non-expert judicial rulings (35.4%), stress related to high-risk patients (34.7%), and litigation costs (35.2%). Factors such as intervention type (32%) and lack of awareness of ethical standards (27.2%) were associated with increased defensive behaviors. General surgery (29.8%) and orthopedics (17%) reported the highest conviction rates. The results showed that defensive medicine is prevalent among surgeons at IUMS due to legal fears and low self-confidence. Enhancing targeted education and establishing clear ethical guidelines may reduce defensive practices and improve surgical care delivery.