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Emergency physicians' experiences with defensive medicine and their motives for acting defensively - an interview

Thorbjørn Hougaard Mikkelsen¹, Mikkel Brabrand², Anne Friesgaard Christensen³

¹PhD, MSc (Soc.), Research Unit of General Practice, Department of Public Health, University of Southern Denmark, Odense, Denmark.

|November 8, 2024

Abstract

Background:

Defensive medicine (DM) has been increasingly studied in recent years. This study aims to investigate the understanding of DM and the motives for practicing DM among emergency physicians.

Methods:

Focus group interviews.

Results:

Themes identified: The understanding of DM, DM is a matter of self-confidence, DM or tests to ensure diagnosis and patient flow, DM due to confounding by availability, DM due to guidelines, Patient-initiated DM, Fear of complaints, DM in an emergency department setting.

Conclusion:

This study shows that emergency physicians perform an abundance of diagnostic tests and investigations but only categorize few of them as DM. The many flow-mediating tests based on guidelines may, however, mask activities that individual physicians would possibly find defensive, if it was up to them to decide based on pure and simple anamnesis and clinical findings. It might be argued that flow optimization has overruled medical clinical reasoning in some ways, thereby introducing an inclination to conduct DM.

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