Malpractice Stress Syndrome and Defensive Medicine in Surgical Specialties: Evidence From Urologists in Turkey

Malpractice litigation is an increasing concern in surgical specialties, with significant psychological and behavioral consequences. Defensive medicine is a frequent response, but data in urology are scarce. This study evaluated malpractice-related stress and defensive medical practices among Turkish urologists.

A cross-sectional online survey was conducted between June and July 2025 among practicing urologists in Turkey. The questionnaire, developed according to the CHERRIES checklist, included demographics, malpractice experiences, anxiety related to litigation, and defensive attitudes. Defensive practices were assessed using the validated Turkish version of the Defensive Medicine Attitude Scale. Statistical analyses were performed with Chi-square, Fisher's Exact, Mann-Whitney U, and Kruskal-Wallis tests.

A total of 152 urologists participated. The largest age group was 30-39 years (32.9%), and 44.7% had ≥ 20 years of experience. Overall, 73% had malpractice lawsuit experience (personal or colleague), and 91.4% reported litigation-related anxiety. High compensation concerns were significantly associated with avoidance of patients likely to sue (p = 0.032) and complex patients (p < 0.001). Senior physicians and those with academic titles more often spent time with patients (p = 0.012, p = 0.014).

Malpractice stress and defensive medicine are highly prevalent among Turkish urologists. These behaviors reflect physicians' psychological burden and influence clinical decision-making. Professional support and legislative reforms are essential to mitigate malpractice-related stress and reduce defensive practices.