Associations between physicians' health-law knowledge and self-reported behaviours and attitudes related to defensive...

This multicentre cross-sectional study examined associations between physicians' health-law knowledge and self-reported behaviours, attitudes, and perceptions related to defensive medicine. Between January and August 2025, physicians at three public hospitals in Istanbul, Türkiye, completed a researcher-developed 19-item questionnaire. Eight factual items formed a criterion-referenced knowledge index; scores of 6-8 were classified as higher knowledge and 0-5 as lower knowledge. Categorical associations were assessed using chi-square or Fisher's exact tests, with Cramér's V and unadjusted odds ratios (ORs) with 95% confidence intervals (CIs). Of approximately 450 questionnaires distributed, 305 complete questionnaires were analysed (approximate completion rate, 67.8%); 191 participants (62.6%) had higher knowledge. Personal self-report that legal responsibilities prompted more detailed laboratory test ordering did not differ significantly between the higher- and lower-knowledge groups (169/191; 88.5% vs 92/114; 80.7%; p = 0.061; V = 0.107; OR = 1.84, 95% CI 0.97-3.50). Physicians with higher knowledge more often believed that stronger legal protection would provide a more suitable environment for a scientific approach to patient care (184/191; 96.3% vs 99/114; 86.8%; p = 0.002; V = 0.178; OR = 3.98, 95% CI 1.57-10.09) and that fear of legal proceedings encourages defensive medicine and more testing than ordinarily necessary (174/191; 91.1% vs 89/114; 78.1%; p = 0.001; V = 0.183; OR = 2.88, 95% CI 1.48-5.60). These findings suggest that measured health-law knowledge may be more closely associated with general medicolegal attitudes than with personal test-ordering self-report. Given the cross-sectional, self-reported, and unadjusted data, no causal inference can be made. Strengthening case-based, clinically integrated medicolegal education and institutional legal support may be considered.