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Defensive Medicine Among Plastic and Aesthetic Surgeons in Israel
Eldad Silberstein1, Ofir Shir-Az1, Haim Reuveni1
1Dr Eldad Silberstein is an Attending Plastic Surgeon, Department of Plastic and Reconstructive Surgery, and Chief of the Head and Neck Reconstruction Unit, Soroka University Medical Center, Beer Sheva, Israel. Mr Shir-Az is a medical student, Faculty of Health Sciences, Ben-Gurion University of the Negev. Prof Reuveni is a Faculty Member, Faculty of Health Sciences. Drs Krieger and Shoham are Attending Plastic Surgeons, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center. Prof Silberstein is a Faculty Member, Faculty of Health Sciences, Ben-Gurion University of the Negev. Dr Bogdanov-Berezovsky is Chief of Plastic Surgery, Department of Plastic and Reconstructive Surgery, Soroka University Medical Center.
Background:
Defensive medicine (DM) includes medical practices that are aimed at avoiding liability rather than benefitting the patient. DM has not been well characterized among plastic surgeons.
Objectives:
The authors examined the extents of intended and unintended DM among members of the Israeli Society of Plastic and Aesthetic Surgery (ISPAS) and identified risk factors for DM.
Methods:
A total of 108 ISPAS members were asked to complete a questionnaire that addressed physician attitudes toward DM and intended or unintended DM practices.
Results:
Seventy-eight surgeons (72.2% response rate) returned the questionnaire, although some questionnaires were returned incomplete. Forty respondents acknowledged practicing DM (ie, DM group), and 33 respondents did not (ie, non-DM group). There were no between-group differences in gender, years of practice, or number of previous litigations. Thirty-one percent of respondents in the DM group indicated that they avoid certain surgical procedures, compared with 6% of respondents in the non-DM group (P = .008). In private practice, 66.2% of respondents stated that they obtain written informed consent twice before surgery, and 100% request preoperative blood-coagulation testing. In contrast, 40% and 74% of respondents in public practice, respectively, acknowledged these behaviors (for consent, P = .027; for testing, P = .0059). Sixty-three percent of respondents prescribe antibiotics for more than 24 hours postoperatively, and this practice was slightly more common in the DM group (34 prescribe antibiotics vs 21 in the non-DM group; P = .079).
Conclusions:
DM is highly integrated into the daily medical practices of plastic surgeons in Israel.
