How defensive medicine is defined in European medical literature: a systematic review.

OBJECTIVES: Defensive medicine has originally been defined as motivated by fear of malpractice litigation. However, the term is frequently used in Europe where most countries have a no-fault malpractice system. The objectives of this systematic review were to explore the definition of the term 'defensive medicine' in European original medical literature and to identify the motives stated therein. DESIGN: Systematic review. DATA SOURCES: PubMed, Embase and Cochrane, 3 February 2020, with an updated search on 6 March 2021. METHODS: Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses, we reviewed all European original peer-reviewed studies fully or partially investigating 'defensive medicine'. RESULTS: We identified a total of 50 studies. First, we divided these into two categories: the first category consisting of studies defining defensive medicine by using a narrow definition and the second category comprising studies in which defensive medicine was defined using a broad definition. In 23 of the studies(46%), defensive medicine was defined narrowly as: health professionals' deviation from sound medical practice motivated by a wish to reduce exposure to malpractice litigation. In 27 studies (54%), a broad definition was applied adding … or other self-protective motives. These self-protective motives, different from fear of malpractice litigation, were grouped into four categories: fear of patient dissatisfaction, fear of overlooking a severe diagnosis, fear of negative publicity and unconscious defensive medicine. Studies applying the narrow and broad definitions of defensive medicine did not differ regarding publication year, country, medical specialty, research quality or number of citations. CONCLUSIONS: In European research, the narrow definition of defensive medicine as exclusively motivated by fear of litigation is often broadened to include other self-protective motives. In order to compare results pertaining to defensive medicine across countries, future studies are recommended to specify whether they are using the narrow or broad definition of defensive medicine. PROSPERO REGISTRATION NUMBER: CRD42020167215.

Does accreditation of general practice promote patient-reported quality of care? A natural cluster randomised experiment.

OBJECTIVE: To investigate whether accreditation of general practice in Denmark promotes patient-reported quality of care and patient satisfaction. DESIGN: A national cluster randomised case control study based on an online version of the Danish Patients Evaluate Practice questionnaire. Mixed effects ordered logit regression models taking account of clustering of patients in different municipalities were used in the analyses. SETTING: General practice in Denmark. PARTICIPANTS: A representative sample of the Danish population. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome measure was patient-reported quality of care, and patient satisfaction with general practice and patient satisfaction with the general practitioner served as secondary outcome measures. RESULTS: In total, 3609 respondents answered the survey. We found no statistically significant relationships between patient-reported quality of care and practice accreditation (2016: OR=0.89, 95% CI 0.73 to 1.07 and 2017: OR=0.85, 95% CI 0.71 to 1.02) and between patient satisfaction with the general practitioner and accreditation (2016: OR=0.93, 95% CI 0.76 to 1.13 and 2017: OR=0.86, 95% CI 0.70 to 1.04). However, there was a statistically significant negative relationship between patient satisfaction with the general practice and recent practice accreditation compared with satisfaction with practices not yet accredited (OR=0.81, 95% CI 0.67 to 0.97) but no significant relationship between patient satisfaction with the general practice and previous accreditation (OR=0.91, 95% CI 0.76 to 1.09). CONCLUSION: Accreditation does not promote patient-reported quality of care or patient satisfaction. On the contrary, patient satisfaction with the general practice decreases when general practice is recently accredited.

How defensive medicine is defined and understood in European medical literature: protocol for a systematic review.

INTRODUCTION: The term defensive medicine, referring to actions motivated primarily by litigious concerns, originates from the USA and has been used in medical research literature since the late 1960s. Differences in medical legal systems between the US and most European countries with no tort legislation raise the question whether the US definition of defensive medicine holds true in Europe. AIM: To present the protocol of a systematic review investigating variations in definitions and understandings of the term 'defensive medicine' in European research articles. METHODS AND ANALYSIS: In concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, a systematic review of all medical research literature that investigate defensive medicine will be performed by two independent reviewers. The databases PubMed, Embase and Cochrane will be systematically searched on the basis of predetermined criteria. Data from all included European studies will systematically be extracted including the studies' definitions and understandings of defensive medicine, especially the motives for doing medical actions that the study regards as 'defensive'. ETHICS AND DISSEMINATION: No ethics clearance is required as no primary data will be collected. The results of the systematic review will be published in a peer-reviewed, international journal. PROSPERO REGISTRATION NUMBER: This review has been submitted to International Prospective Register of Systematic Reviews (PROSPERO) and is awaiting registration.

Retirement, job satisfaction and attitudes towards mandatory accreditation: a Danish survey study in general practice.

OBJECTIVES: This study aims to analyse the associations between general practitioner (GP) retirement, job satisfaction and attitudes towards a mandatory accreditation scheme. External interventions such as mandatory accreditation schemes may be perceived negatively by GPs, causing early retirement from practice. In Denmark, almost half of the GPs had negative attitudes prior to the implementation of a mandatory accreditation scheme, constituting a possible risk of early practice retirement. SETTING: In January 2015 all 3,404 Danish GPs were invited to participate in a survey on attitudes towards a forthcoming mandatory accreditation programme. PARTICIPANTS: 1,906 GPs (56%) answered the questionnaire. In total, 391 (11%) retired from practice in the following period from 1 January 2015 to 31 January 2017. Of these, 193 GPs (49%) answered the questionnaire. PRIMARY AND SECONDARY OUTCOME MEASURES: The primary outcome was GP retirement. Labour union data on practice retirement were linked with data from the questionnaire survey on job satisfaction and attitudes prior to implementation of mandatory accreditation. Logistic regression analyses were used to determine the associations between practice retirement and job satisfaction and attitudes towards accreditation. RESULTS: Practice retirement was associated with job dissatisfaction (OR: 2.5, 95% CI 1.6 to 3.7). Retirement was not associated with any of the other surveyed attitudinal variables. Retirement rate was relatively high in the accreditation start-up period. CONCLUSION: Practice retirement was associated with job dissatisfaction but not to a priori attitudes towards an upcoming mandatory accreditation programme. However, the retirement rate was relatively high in the start-up period of the accreditation programme. Future research should evaluate the effects of external interventions on preterm retirement from general practice. TRIAL REGISTRATION NUMBER: NCT02762240.