Article Text

Download PDFPDF

How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners
  1. Elisabeth Assing Hvidt1,
  2. Jesper Lykkegaard1,
  3. Line Bjørnskov Pedersen1,2,
  4. Kjeld Møller Pedersen3,
  5. Anders Munck1,
  6. Merethe Kousgaard Andersen1
  1. 1 Department of Public Health, Research Unit of General Practice, University of Southern Denmark, Odense, Denmark
  2. 2 Department of of Business and Economics, COHERE, University of Southern Denmark, Odense, Denmark
  3. 3 Department of of Business and Economics, COHERE, University of Southern Denmark, Odense, Denmark
  1. Correspondence to Dr Elisabeth Assing Hvidt; ehvidt{at}health.sdu.dk

Abstract

Objectives Recent years have witnessed a progressive increase in defensive medicine (DM) in several Western welfare countries. In Danish primary and secondary care, documentation on the extent of DM is lacking. Before investigating the extent of DM, we wanted to explore how the phenomenon is understood and experienced in the context of general practice in Denmark. The objective of the study was to describe the phenomenon of DM as understood and experienced by Danish general practitioners (GPs).

Design A qualitative methodology was employed and data were generated through six focus group interviews with three to eight GPs per group (n=28) recruited from the Region of Southern Denmark. Data were analysed using a thematic content analysis inspired by a hermeneutic-phenomenological focus on understanding and meaning.

Results DM is understood as unnecessary and meaningless medical actions, carried out mainly because of external demands that run counter to the GP’s professionalism. Several sources of pressure to act defensively were identified by the GPs: the system’s pressure to meet external regulations, demands from consumerist patients and a culture among GPs and peers of infallibility and zero-risk tolerance.

Conclusions GPs understand DM as unnecessary and meaningless actions driven by external demands instead of a focus on the patient’s problem. GPs consider defensive actions to be carried out as a result of succumbing to various sources of pressure deriving from the system, the patients, the GPs themselves and peers.

  • defensive medicine
  • general practice
  • primary health care
  • qualitative research

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

Statistics from Altmetric.com

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Footnotes

  • Contributors EAH, JL, LBP, KMP, AM and MKA were involved in study conception and design. EAH and MKA were involved in acquisition of data. EAH, JL, LBP, KMP, AM and MKA were involved in analysis and interpretation of data. EAH and MKA were involved in drafting of manuscript. JL, LBP, KMP and AM were involved in critical revision of the manuscript.

  • Funding This project was funded by the Committee of Quality and Continuing Education Region of Southern Denmark (Kvali-projekt 07/16) (grant number: 16/16269).

  • Competing interests None declared.

  • Ethics approval Ethics approval was granted by The Danish Data Protection Agency (J. number: 16/46654).

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data are available.