Vimercati A, Greco P, Kardashi A, Rossi C, Loizzi V, Scioscia M, Loverro G
Department of Obstetrics and Gynecology, University of Bari, Italy.
J Perinat Med. 2000;28(2):111-7. doi: 10.1515/JPM.2000.014.
To evaluate the perception of "Defensive Medicine" by hospital based obstetricians and the influence of this attitude on the choice of cesarean delivery.
Questionnaire sent by mail to a sample (76) of obstetricians of general district, teaching and university hospitals in a region of southern Italy (Puglia). Doctors were selected as the head, the most senior and the most junior specialist of each department. Independent variables of the study were considered as demographic data of the subjects, years of service, interest in private practice, size of the hospital, background cesarean section rate, personal and site of work exposure to legal claims. Outcome measures were experience and confidence in training for operative vaginal and breech delivery, use of the partogram in labor, opinion about a trial of labor after a previous cesarean section and about cesarean section on request, personal perception of defensive medicine. Univariate and multivariate analysis of data were performed.
The response rate was 83%. According to our data, seniority in service meant confidence in and request of more teaching of obstetrics manoeuvres, size of hospitals was positively related to a more rationale approach of the diagnosis of dystocia, heads of units were keener to accept the patient's wish for a cesarean section. Doctors with large private practices were less likely to be sued and the perception of legal pressure was directly related to the rate of cesarean section in each unit.
Defensive Medicine is a reality that encompasses all categories of doctors in this survey. The only differences were in the rate of perception of legal pressure. We believe that residential programs should be modified in order to improve specialists' understanding of malpractice problems and that the patient-doctor relationship should be ameliorated in public hospitals.
评估意大利南部普利亚地区综合医院、教学医院及大学医院的产科医生对“防御性医疗”的认知，以及这种态度对剖宫产选择的影响。
通过邮件向意大利南部普利亚地区一个样本（76名）的综合医院、教学医院及大学医院的产科医生发放问卷。选取各科室的主任、资历最深和最浅的专家作为研究对象。研究的自变量包括受试者的人口统计学数据、工作年限、对私人执业的兴趣、医院规模、既往剖宫产率、个人及工作场所面临法律诉讼的情况。观察指标包括对阴道助产和臀位分娩培训的经验和信心、产程图在分娩中的使用、对既往剖宫产术后试产及选择性剖宫产的看法、对防御性医疗的个人认知。对数据进行单因素和多因素分析。
回复率为83%。根据我们的数据，工作年限越长，对产科操作教学的信心和需求越高；医院规模越大，对难产诊断的方法越合理；科室主任更倾向于接受患者剖宫产的意愿。私人执业较多的医生被起诉的可能性较小，对法律压力的认知与各科室的剖宫产率直接相关。
在本次调查中，防御性医疗是一个涵盖所有医生类别的现实情况。唯一的差异在于对法律压力的认知程度。我们认为，应修改住院医师培训项目，以提高专科医生对医疗事故问题的理解，并且应改善公立医院的医患关系。
