Catino Maurizio, Celotti Simona
University of Milan - Bicocca (Italy).
Stud Health Technol Inform. 2009;148:206-21.
Defensive medicine takes place when healthcare personnel modify their behaviour with the aim of reducing their exposure to legal challenges from patients. The phenomenon is directly related to the significant growth in medical malpractice litigation over recent years. This article presents the results of two research surveys aimed at measuring the extent of defensive behaviours on the part of doctors in Italy and at understanding the reasons for them. The first study (the National Study (NS) was conducted in respect of a nation-wide sample of general practitioners, while the second (the Local Study (LS) was conducted in respect of two groups of specialists (surgeons and anaesthetists) in a regional hospital. 77.9% of the general practitioners interviewed for the NS (responses were received from 37% of the 1000 GPs to whom the questionnaire was sent) declared that they had practiced at least one form of defensive medicine during the previous working month. The figure for the LS was 83.3%. This article discusses the factors, such as the blame culture and the increase in medical malpractice litigation, that may lead to defensive behaviours and result in negative effects both in terms of costs and patient safety. A clear need emerges for a different approach to the problem of medical error - at a cultural, organizational and legal level - just as in the case of other organizations subject to high risk. The deterrent of punishment does not increase the reliability of such organizations, nor does it improve the level of safety in them.
当医护人员改变其行为目的是减少患者法律挑战风险时，就会出现防御性医疗行为。这一现象与近年来医疗事故诉讼的显著增加直接相关。本文介绍了两项研究调查的结果，旨在衡量意大利医生防御性医疗行为的程度，并了解其背后的原因。第一项研究（全国性研究（NS））针对全国范围内的全科医生样本进行，第二项研究（地方性研究（LS））针对一家地区医院的两组专科医生（外科医生和麻醉师）进行。接受NS调查的全科医生中有77.9%（问卷发送给了1000名全科医生，其中37%回复）表示，他们在前一个工作月中至少实施了一种形式的防御性医疗行为。LS的这一比例为83.3%。本文讨论了诸如指责文化和医疗事故诉讼增加等因素，这些因素可能导致防御性医疗行为，并在成本和患者安全方面产生负面影响。在文化、组织和法律层面，如同对待其他高风险组织一样，显然需要一种不同的方法来解决医疗差错问题。惩罚的威慑作用既不会提高此类组织的可靠性，也不会提升其安全水平。
