Defensive healthcare practice: systematic review of qualitative evidence

ObjectiveTo synthesise qualitative evidence on clinicians’ views and experiences of defensive practice.DesignSystematic review of qualitative data.Data sourcesMEDLINE, Embase, PsycINFO, AMED, Maternity and Infant Care, CINAHL, ASSIA, Sociological Abstracts, Proquest Dissertations & Theses and PR...

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Published inBMJ open Vol. 14; no. 7; p. e085673
Main Authors Lorenc, Theo, Khouja, Claire, Harden, Melissa, Fulbright, Helen, Thomas, James
Format Journal Article
LanguageEnglish
Published England British Medical Journal Publishing Group 18.07.2024
BMJ Publishing Group LTD
BMJ Publishing Group
Subjects
Attitude of Health Personnel
clinical decision-making
Clinical medicine
Decision making
Defensive Medicine
Health care expenditures
Health Services Research
Humans
Litigation
medical law
Medicine
Original Research
Patients
physicians
Qualitative Research
Systematic review
United States > US
medical law
physicians
clinical decision-making
qualitative research
systematic review
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Summary:ObjectiveTo synthesise qualitative evidence on clinicians’ views and experiences of defensive practice.DesignSystematic review of qualitative data.Data sourcesMEDLINE, Embase, PsycINFO, AMED, Maternity and Infant Care, CINAHL, ASSIA, Sociological Abstracts, Proquest Dissertations & Theses and PROSPERO were searched from 2000 to October 2023.Eligibility criteriaWe included English-language studies of clinicians which reported qualitative data on the impact of litigation or complaints on clinical practice.Data extraction and synthesisWe coded findings data line by line using a grounded theory approach. We assessed quality using Hawker et al’s tool and synthesised data thematically.Results17 studies were included. Participants identify a range of clinical decisions which may be defensively motivated, relating to diagnosis and documentation as well as to treatment. Defensive practice often relates to a diffuse sense of risk rather than the direct threat of litigation and may overlap with other motivations, such as perceived pressure from patients or the desire to avoid harm. Defensive practice is seen to be harmful in many ways, but again, these perceptions may gain force from broader narratives of mistrust and disempowerment, as much as from the risk of litigation.ConclusionsThe idea of defensive practice, as enacted, is more complex than some theoretical accounts suggest and may often function to express broader concerns about the work of clinical care. The qualitative evidence calls into question the view of defensive practice as a key mediator linking litigation risk to inappropriate treatment and excess costs.
Bibliography:Original research
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Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
None declared.
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2024-085673