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Mental health
Research
Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists
  1. I Reuveni1,
  2. I Pelov1,
  3. H Reuveni2,
  4. O Bonne1,
  5. L Canetti1,3
  1. 1Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem, Israel
  2. 2Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
  3. 3Department of Psychology, Hebrew University, Jerusalem, Israel
  1. Correspondence to Dr I Reuveni; reuveni{at}hadassah.org.il

Abstract

Objective Psychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists and to understand whether awareness of DP correlated with defensive behaviours.

Methods A questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims.

Results Forty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved in malpractice claims, while 132 (62.1%) participants admitted to practising DP. Residents acknowledged the practice of DP more than did senior psychiatrists (p=0.038).

Awareness of DP correlated with unnecessary hospitalisation of suicidal patients, increased unnecessary follow-up visits and prescribing smaller drug dosages than required for pregnant women and elderly patients.

Conclusions This study provides evidence that DP is well established in the routine clinical daily practice of psychiatrists. Further studies are needed to reveal whether DP effectively protects psychiatrists from malpractice suits or, rather, if it impedes providing quality psychiatric care and represents an economic burden that leads to more harm for the patient.

  • Defensive Medicine
  • Defensive Psychiatry (DP)
  • Medical Malpractice

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/

https://doi.org/10.1136/bmjopen-2016-014153

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    Footnotes

    • IR and IP contributed equally to this article.

    • Contributors All authors contributed extensively to the work presented in this paper. IR and IP designed the study, collected data and wrote the manuscript. HR conceived the study and edited the prepared manuscript. OB supervised the data collection and analysis and edited the manuscript. LC performed the statistical analysis, interpreted the data and wrote the manuscript.

    • Funding This research received no specific grant from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

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

    • Data sharing statement Supporting data are available on request. Please contact the corresponding author reuveni@hadassah.org.il.