defensive medicine


Summary: The alterations of modes of medical practice, induced by the threat of liability, for the principal purposes of forestalling lawsuits by patients as well as providing good legal defense in the event that such lawsuits are instituted.

Top Publications

  1. Zwecker P, Azoulay L, Abenhaim H. Effect of fear of litigation on obstetric care: a nationwide analysis on obstetric practice. Am J Perinatol. 2011;28:277-84 pubmed publisher
    ..Fear of litigation appears to have a marked effect on obstetric practice, particularly total cesarean delivery, vaginal birth after cesarean, and instrumental delivery, when malpractice premiums rise above $100,000 per annum. ..
  2. Brown H. Lawsuit activity, defensive medicine, and small area variation: the case of Cesarean sections revisited. Health Econ Policy Law. 2007;2:285-96 pubmed publisher
    ..After extracting the variation in delivery practice between hospitals and between Dartmouth Hospital Referral Regions in a multilevel model, the effects of lawsuits on defensive medicine are reduced but are still significant.
  3. Sathiyakumar V, Jahangir A, Mir H, Obremskey W, Lee Y, Apfeld J, et al. The prevalence and costs of defensive medicine among orthopaedic trauma surgeons: a national survey study. J Orthop Trauma. 2013;27:592-7 pubmed publisher
    b>Defensive medicine includes medical practices that exonerate physicians from liability without benefit to patients. The national prevalence of defensive medicine in orthopaedic trauma surgery has not been investigated...
  4. Elli L, Tenca A, Soncini M, Spinzi G, Buscarini E, Conte D. Defensive medicine practices among gastroenterologists in Lombardy: between lawsuits and the economic crisis. Dig Liver Dis. 2013;45:469-73 pubmed publisher
    b>Defensive medicine is becoming more frequent behaviour and has an impact on the economic 'health' of national healthcare systems...
  5. Sethi M, Obremskey W, Natividad H, Mir H, Jahangir A. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Am J Orthop (Belle Mead NJ). 2012;41:69-73 pubmed
    b>Defensive medicine is defined as medical practices that may exonerate physicians from liability without significant benefit to patients...
  6. Brilla R, Evers S, Deutschlander A, Wartenberg K. Are neurology residents in the United States being taught defensive medicine?. Clin Neurol Neurosurg. 2006;108:374-7 pubmed
    To study whether and how fear of litigation and defensive medicine are communicated during residency training and to assess whether this affects residents' attitudes...
  7. Asher E, Greenberg Dotan S, Halevy J, Glick S, Reuveni H. Defensive medicine in Israel - a nationwide survey. PLoS ONE. 2012;7:e42613 pubmed publisher
    b>Defensive medicine is the practice of diagnostic or therapeutic measures conducted primarily as a safeguard against possible malpractice liability...
  8. Tussing A, Wojtowycz M. Malpractice, defensive medicine, and obstetric behavior. Med Care. 1997;35:172-91 pubmed
    ..examine 58,441 obstetric deliveries in New York State outside New York City to test for the existence of defensive medicine in obstetrics...
  9. Rodriguez R, Anglin D, Hankin A, Hayden S, Phelps M, McCollough L, et al. A longitudinal study of emergency medicine residents' malpractice fear and defensive medicine. Acad Emerg Med. 2007;14:569-73 pubmed
    To determine the baseline level and evolution of defensive medicine and malpractice concern (MC) of emergency medicine (EM) residents...

More Information


  1. Murphy J. When careful medicine becomes defensive medicine. Ir Med J. 2004;97:292 pubmed
  2. Avraham R. Clinical practice guidelines: the warped incentives in the U.S. healthcare system. Am J Law Med. 2011;37:7-40 pubmed
    ..Lastly, this article proposes a private regulation regime that could be a solution which would align all of the players' incentives to society's interests. ..
  3. O Leary K, Choi J, Watson K, Williams M. Medical students' and residents' clinical and educational experiences with defensive medicine. Acad Med. 2012;87:142-8 pubmed publisher
    To assess medical students' and residents' experiences with defensive medicine, which is any deviation from sound medical practice due to a perceived threat of liability through either assurance or avoidance behaviors...
  4. Nahed B, Babu M, Smith T, Heary R. Malpractice liability and defensive medicine: a national survey of neurosurgeons. PLoS ONE. 2012;7:e39237 pubmed publisher
    ..and malpractice risk rise to crisis levels, the medical-legal environment has contributed to the practice of defensive medicine as practitioners attempt to mitigate liability risk...
  5. Bleich A, Baruch Y, Hirschmann S, Lubin G, Melamed Y, Zemishlany Z, et al. Management of the suicidal patient in the era of defensive medicine: focus on suicide risk assessment and boundaries of responsibility. Isr Med Assoc J. 2011;13:653-6 pubmed
    ..when treating suicidal patients, focusing on risk assessment and boundaries of responsibility, in the era of defensive medicine. The final draft of the position paper was by consensus...
  6. Toker A, Shvarts S, Perry Z, Doron Y, Reuveni H. Clinical guidelines, defensive medicine, and the physician between the two. Am J Otolaryngol. 2004;25:245-50 pubmed
    ..5%) physicians. Eighty-nine physicians (45.4%) specifically stated that the reason for this behavior is defensive medicine, thirty-two physicians (16...
  7. Asher E, Dvir S, Seidman D, Greenberg Dotan S, Kedem A, Sheizaf B, et al. Defensive medicine among obstetricians and gynecologists in tertiary hospitals. PLoS ONE. 2013;8:e57108 pubmed publisher
    To describe the daily work practice under the threat of defensive medicine among obstetricians and gynecologists. A prospective cross-sectional survey of obstetricians and gynecologists working at tertiary medical centers in Israel...
  8. Studdert D, Mello M, Sage W, DesRoches C, Peugh J, Zapert K, et al. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA. 2005;293:2609-17 pubmed
    How often physicians alter their clinical behavior because of the threat of malpractice liability, termed defensive medicine, and the consequences of those changes, are central questions in the ongoing medical malpractice reform debate...
  9. Hiyama T, Yoshihara M, Tanaka S, Urabe Y, Ikegami Y, Fukuhara T, et al. Defensive medicine practices among gastroenterologists in Japan. World J Gastroenterol. 2006;12:7671-5 pubmed
    To clarify the prevalence of defensive medicine and the specific defensive medicine practices among gastroenterologists in Japan. A survey of gastroenterologists in Hiroshima, Japan, was conducted by mail in March 2006...
  10. Sloan F, Shadle J. Is there empirical evidence for "Defensive Medicine"? A reassessment. J Health Econ. 2009;28:481-91 pubmed publisher
    ..The overall conclusion is that tort reforms do not significantly affect medical decisions, nor do they have a systematic effect on patient outcomes. ..
  11. Catino M, Celotti S. The problem of defensive medicine: two Italian surveys. Stud Health Technol Inform. 2009;148:206-21 pubmed
    b>Defensive medicine takes place when healthcare personnel modify their behaviour with the aim of reducing their exposure to legal challenges from patients...
  12. Michota F, Donnelly M. Medicolegal issues in perioperative medicine: Lessons from real cases. Cleve Clin J Med. 2009;76 Suppl 4:S119-25 pubmed publisher
  13. Hermer L, Brody H. Defensive medicine, cost containment, and reform. J Gen Intern Med. 2010;25:470-3 pubmed publisher
    The role of defensive medicine in driving up health care costs is hotly contended. Physicians and health policy experts in particular tend to have sharply divergent views on the subject...
  14. Chen X. Defensive medicine or economically motivated corruption? A confucian reflection on physician care in China today. J Med Philos. 2007;32:635-48 pubmed
    ..These practices have been interpreted as defensive medicine in response to a rising threat of potential medical malpractice lawsuits...
  15. Reed D, Windish D, Levine R, Kravet S, Wolfe L, Wright S. Do fears of malpractice litigation influence teaching behaviors?. Teach Learn Med. 2008;20:205-11 pubmed publisher
    ..These results may serve to heighten awareness to the fact that teaching behaviors and decisions may be influenced by the malpractice climate. ..
  16. Mello M, Chandra A, Gawande A, Studdert D. National costs of the medical liability system. Health Aff (Millwood). 2010;29:1569-77 pubmed publisher
    ..interest in medical liability reforms and their potential to save money by reducing the practice of defensive medicine. It is not easy to estimate the costs of the medical liability system, however...
  17. Feess E. Malpractice liability, technology choice and negative defensive medicine. Eur J Health Econ. 2012;13:157-67 pubmed publisher
    ..We refer to this distortion toward the safe technology as negative defensive medicine. Taking the problem of negative defensive medicine seriously, the second best optimal liability needs to ..
  18. Passmore K, Leung W. Defensive practice among psychiatrists: a questionnaire survey. Postgrad Med J. 2002;78:671-3 pubmed
  19. Amon E, Winn H. Review of the professional medical liability insurance crisis: lessons from Missouri. Am J Obstet Gynecol. 2004;190:1534-8; discussion 1538-40 pubmed
    ..Specialists are less willing to care for emergency and indigent patients for fear of liability exposure. Legislative enactments leading to meaningful tort reform, public support, and judicial restraint must occur to save health care. ..
  20. Neale G. Medical litigation: past, present and future. Hosp Med. 2004;65:4-5 pubmed
  21. Mahar P, Burke J. What is the value of professional opinion? The current medicolegal application of the "peer professional practice defence" in Australia. Med J Aust. 2011;194:253-5 pubmed
    ..Recent cases demonstrate the successful operation of the peer professional practice defence, but also highlight its limitations. In practice, the legislation may not shield doctors from negligence claims as fully as originally intended. ..
  22. Sartwelle T, Johnston J. Neonatal encephalopathy 2015: opportunity lost and words unspoken. J Matern Fetal Neonatal Med. 2016;29:1372-5 pubmed publisher
  23. Dubay L, Kaestner R, Waidmann T. The impact of malpractice fears on cesarean section rates. J Health Econ. 1999;18:491-522 pubmed
    A longstanding issue in the health care industry is whether physicians' malpractice fears lead to defensive medicine. We use national birth certificate data from 1990 through 1992 to conduct a county fixed-effects analysis of the impact ..
  24. Levine J, Savino F, Peterson M, Wolf C. Risk management for pressure ulcers: when the family shows up with a camera. J Am Med Dir Assoc. 2008;9:360-3 pubmed publisher
  25. Rovit R, Simon A, Drew J, Murali R, Robb J. Neurosurgical experience with malpractice litigation: an analysis of closed claims against neurosurgeons in New York State, 1999 through 2003. J Neurosurg. 2007;106:1108-14 pubmed
    ..Elective spinal surgery cases constitute the majority of litigation. Neurosurgeons can take steps to reduce their vulnerability to potential litigation and to increase the odds of a successful defense. ..
  26. Leigh B. What's the problem?. BMJ. 2004;328:460 pubmed
  27. Shepherd B, MacPherson D, Edwards C. In-flight emergencies: playing The Good Samaritan. J R Soc Med. 2006;99:628-31 pubmed
  28. Searle S. Service standards for sexual health. J Fam Plann Reprod Health Care. 2004;30:131 pubmed
  29. Sicot C. [Insurance management of medical risks]. Gastroenterol Clin Biol. 2004;28:513-4 pubmed
  30. Robeznieks A. Wary physicians. Defensive medicine linked to higher costs, less access. Mod Healthc. 2005;35:8-9 pubmed
  31. Chee Y. Do no harm: do thyself no harm. Singapore Med J. 2005;46:667-74 pubmed
  32. Craig P. Should there be "caps" on pain and suffering awards for medical malpractice cases?. MCN Am J Matern Child Nurs. 2002;27:142 pubmed
  33. Zinn C. Medical insurance crisis hits Australia's surgeons. BMJ. 2002;325:510 pubmed
  34. Studdert D, Mello M, Brennan T. Medical malpractice. N Engl J Med. 2004;350:283-92 pubmed
  35. Pellerin D. [From the caution principle to the unpredictable medical risk: which medicine for the future?]. Arch Pediatr. 2004;11:197-200 pubmed
  36. Alamri A, Apok V, Crocker M, Powell M. Sir Victor Horsley (1857-1916): lessons for the modern clinician. Br J Neurosurg. 2011;25:470-4 pubmed publisher
    ..These lessons should empower modern clinicians to retain the professionalism they worry about losing. ..
  37. Foucar E. Pathology expert witness testimony and pathology practice: a tale of 2 standards. Arch Pathol Lab Med. 2005;129:1268-76 pubmed
  38. DeWeese J. Offensive defensive medicine. Orthopedics. 2006;29:296-7 pubmed
  39. Baicker K, Buckles K, Chandra A. Geographic variation in the appropriate use of cesarean delivery. Health Aff (Millwood). 2006;25:w355-67 pubmed
    ..Areas with higher usage rates perform the intervention in medically less appropriate populations-that is, relatively healthier births-and do not see improvements in maternal or neonatal mortality. ..
  40. Kaye A. Mammography and monkey bars. J Am Coll Radiol. 2004;1:379-80 pubmed
  41. Hendee W, Becker G, Borgstede J, Bosma J, Casarella W, Erickson B, et al. Addressing overutilization in medical imaging. Radiology. 2010;257:240-5 pubmed publisher
    ..behavior of referring physicians; self-referral, including referral for additional radiologic examinations; defensive medicine; missed educational opportunities when inappropriate procedures are requested; patient expectations; and ..
  42. Loizides S, Kallis A, Oswal A, Georgiou P, Kallis G, Gavalas M. Chaperone policy in accident and emergency departments: a national survey. J Eval Clin Pract. 2010;16:107-10 pubmed publisher
  43. Monteiro F. [Mechanical ventilation and medical futility or dysthanasia, the dialectic of high technology in intensive medicine]. Rev Port Pneumol. 2006;12:281-91 pubmed
    ..The understanding of this posture implies a philosophical approach and reflexion of medical practice. ..
  44. Shutack C. A closed claim analysis--defense team's expertise wins case for physician. Mich Med. 2008;107:8 pubmed
  45. McCoubrie P, Reid J. Development of medical imaging technologies is the best way to advance clinical diagnostic accuracy and there is no such thing as VOMIT. J R Coll Physicians Edinb. 2012;42:326-32 pubmed publisher
    ..Can we control inadequate imaging request strategies? ..
  46. Meningaud J, Wolf M, Herve C. [Voluntary consent: basic premise, ideal or utopia?]. Rev Stomatol Chir Maxillofac. 2002;103:325-6 pubmed
  47. Decastello A. [Mediation in health]. Orv Hetil. 2008;149:265-9 pubmed publisher
    ..At present, data are supplied on an optional basis and it cannot be supported. ..
  48. Tena Tamayo C, Sánchez González J. [Assertive medicine: a proposal against defensive medicine]. Ginecol Obstet Mex. 2005;73:553-9 pubmed diverse factors, among these liability complaints stand out, and have propitiated the practice of defensive medicine, an attitude considered in many countries as inappropriate, expensive and unethical...
  49. Smith Bindman R, McCulloch C, Ding A, Ding A, Quale C, Chu P. Diagnostic imaging rates for head injury in the ED and states' medical malpractice tort reforms. Am J Emerg Med. 2011;29:656-64 pubmed publisher
    ..The tort reforms we examined were associated with the propensity to obtain neurologic imaging. If these results are confirmed in larger studies, tort reform might mitigate defensive medical practices. ..
  50. Avery J. The way things should go: Part II. Tenn Med. 2004;97:497-8 pubmed
  51. Capstick B. The future of clinical negligence litigation?. BMJ. 2004;328:457-9 pubmed
  52. Day M. Doctors attack Gordon Brown's plans to regulate medical profession. BMJ. 2007;335:113 pubmed
  53. Van Arsdall J. To err is human, communication is divine. J Ky Med Assoc. 2007;105:509-10 pubmed