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. 2025 Jul 11.
doi: 10.1227/neu.0000000000003620. Online ahead of print.

Defensive Medicine in Neurosurgery: The Sub-Saharan Africa Experience

François Waterkeyn  1 , Chibuikem A Ikwuegbuenyi  2 , Simon A Balogun  3 , Myriam Thys  1 , Romani R Sabas  4 , Hervé M Lekuya  5 , Dominique Vanpee  6
Affiliations

Defensive Medicine in Neurosurgery: The Sub-Saharan Africa Experience

François Waterkeyn et al. Neurosurgery. .

Abstract

Background and objectives: This study investigates the prevalence and determinants of defensive medicine among neurosurgeons in Sub-Saharan Africa (SSA). It examines how economic, cultural, and legal factors unique to SSA influence these practices, providing insights to guide regional policy-making and medical education.

Methods: A cross-sectional survey of 71 neurosurgeons in SSA was conducted via WhatsApp, LinkedIn, and conferences. The questionnaire, adapted to the SSA context from a Canadian study, explored demographics, practice types, liability profiles, defensive behaviors, and perceptions of the medicolegal environment. Data were analyzed using descriptive statistics in R software.

Results: Among 71 respondents, 91.5% were men, and 29.6% were undergoing residency or fellowship training. All respondents reported engaging in at least 1 defensive medical behavior, with varying degrees of frequency. Common strategies included patient discussions (24.2%) and specialist referrals (16.7%). Economic and resource limitations constrained practices such as ordering imaging (17.5%) and prescribing medications (10.8%). Despite perceived medicolegal risks, 93% of participants reported no lawsuits in the past 3 years.

Conclusion: Defensive medicine among neurosurgeons in SSA is less prevalent and intense than in high-income regions. Unique economic constraints, cultural norms, and weaker legal pressures limit defensive behaviors. These findings highlight the need for context-specific policies and educational strategies to balance medicolegal risk management with resource limitations in SSA.

Keywords: Defensive medicine; Neurosurgery; Sub-Saharan Africa.

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References

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