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. 2023 Apr;29(3):529-538.
doi: 10.1111/jep.13799. Epub 2022 Nov 26.

Factors influencing defensive medicine-based decision-making in primary care: A scoping review

Christina J Strobel  1 , Dorothee Oldenburg  1 , Jost Steinhäuser  1
Affiliations

Factors influencing defensive medicine-based decision-making in primary care: A scoping review

Christina J Strobel et al. J Eval Clin Pract. 2023 Apr.

Abstract

Rationale, aims and objectives: Medical decision-making processes in primary care are influenced by defensive medical practice. This involves a high possibility for negative consequences on many levels, for example, patient's health, health care system costs and a crisis of trust in the patient-doctor relationship. Aim of this review was to identify factors of defensive medicine-based decision-making in primary care.

Methods: This scoping review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping reviews (PRISMA-ScR) guidelines and included systematic research on MEDLINE, Google Scholar and two German databases for additional grey literature. References provided further literature. Articles in English and German published from 1 January 1982 to 15 June 2022 were assessed.

Results: From 911 publications screened, 13 publications [6 qualitative studies and 7 quantitative (3 cross-sectional) studies] were included. In these, four main categories of factors influencing defensive medical practice were identified: (social) media, patients adopting a consumer attitude, health care system based working conditions and physician's tolerance for uncertainty. Pressure deriving from these four different sources is exerted on the general practitioner and may result in a defensive medical decision behaviour.

Conclusions: Four categories on influencing factors of defensive medicine could be identified. Strategies to tolerate uncertainty should be trained in under- and postgraduate training.

Keywords: decision-making; defensive medicine; factors; general practitioners; influence; overdiagnosis; primary care.

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References

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