Policy Options for Reducing Defensive Medicine Behaviors: A Multi-Method Study

Area of Science:

• Health Policy
• Medical Ethics
• Healthcare Management

Background:

• Defensive medicine (DM) involves clinical decisions made to avoid legal or reputational risks, increasing costs and compromising patient safety.
• This study addresses the need for policy options to mitigate DM behaviors within the healthcare system.

Purpose of the Study:

• To identify and categorize policy options, strategies, and considerations for reducing defensive medicine behaviors.
• To provide a framework for implementing interventions at various levels of the healthcare system.

Main Methods:

• A comprehensive scoping review of literature from 2000-2023 across major databases (Web of Science, PubMed, ProQuest, Scopus).
• Focus group discussions and expert panel sessions were utilized to refine identified policies, strategies, advantages, disadvantages, and implementation considerations.

Main Results:

• Four primary policy options were formulated: evidence-based medicine, legal reforms, promotion of professional ethics and a supportive environment, and improving the doctor-patient relationship.
• The study identified 13 interventions, 18 advantages, 18 disadvantages, and 21 implementation considerations for managing DM behaviors.
• A total of 1774 articles were initially retrieved, with 58 ultimately included in the analysis.

Conclusions:

• Reducing defensive medicine requires multi-level interventions, encompassing macro, organizational, and individual strategies.
• Enhancing clinician knowledge and skills, fostering a supportive organizational culture, and promoting ethical conduct are crucial for mitigating DM.
• Improving the doctor-patient relationship is essential for addressing defensive medicine practices.