Blame culture and defensive medicine

Defensive medicine takes place when healthcare personnel (doctors and nurses) order unnecessary treatments (positive defensive medicine) or avoid high-risk procedures or patients (negative defensive medicine) with the principle—though not exclusive—aim of reducing their expose to damages claims. This phenomenon is directly related to the significant growth in medical malpractice litigation over recent years. Defensive medicine increases the cost of healthcare and may expose patients to unnecessary risks. In fact, the large number of legal initiatives taken by patients have induced many doctors to set in place a defensive ‘‘strategy’’ so as to avoid placing their careers at risk. The threat of medical malpractice litigation constitutes a major obstacle to improving the reliability of healthcare organizations and patient safety. Method and survey results This article presents the results of a recent research survey aimed at measuring the frequency of defensive behaviors in a sample of general practitioners and at understanding the reasons for them. 77.9% of the interviewees (responses were received from 30% of the 1,000 general practitioners to whom the questionnaire was sent) declared that they had practiced at least one form of positive defensive medicine during the previous working month. As far as the practice of negative defensive medicine is concerned, 26.2% of the interviewees declared that they had excluded from certain treatments patients subject to risk (i.e. beyond the dictates of a normal level of prudence). Discussion and conclusion The phenomenon of defensive medicine is constantly increasing in Italy as in other countries. This increase is caused by the substantial increase in malpractice medical litigation. A punitive approach to error in hospitals encourages the phenomenon of defensive medicine and acts as an obstacle to the detection and reporting of error. This article discusses the factors, such as the blame culture and the increase in medical malpractice litigation, that may lead to defensive behaviors and result in negative effects both in terms of costs and patient safety. A clear need emerges for a different approach—at a cultural, organizational, and legal level—to the problem of medical error, just as in the case of other organizations subject to high risk. The deterrent of punishment does not increase the reliability of such organizations, nor does it improve the level of safety in them.