Physicians’ perception about defensive medicine in primary healthcare: cross-sectional study

Background and purpose: Defensive medicine is defined as a deviation from standard medical practice for fear of medical malpractice claims and has serious consequences for patients, doctors, and public funds. We aim to understand the perception of defensive medicine practice in primary health care, specifically in the Health Centers Group of Western Lisbon and Oeiras (HCG WLO). Methods: We conducted a cross-sectional study between May 2019 and September 2020, including all 182 physicians working at HCG WLO. Each participant received a questionnaire to answer within two months, and the results were analyzed through SPSS®, v. 27. Results: We included 138 questionnaires (11 excluded and 33 not answered). 61% of physicians consider defensive medicine a moderate problem, and 92.2% have already practiced defensive medicine, which includes ordering additional exams (93.7%), referring to secondary care (53.2%), and scheduling further appointments (34.9%). The main reasons for defensive medicine are the need for more information to make safer decisions (63.8%) and patient insistence on performing extra procedures (55.9%). 68.3% believe that practicing defensive medicine reduces malpractice claims. Discussion: Most physicians had already practiced defensive medicine once in their lives. They consider it a problem and recognize its elevated costs. They believe in protocol development, legal support improvement, consultation time adjustment, and health literacy promotion to diminish the problem. It was not possible to establish an association between workplace and defensive medicine practice due to the low number of participants. The research team aims to apply this protocol nationwide for more valid results and to promote new policies.