Reuveni I, Pelov I, Reuveni H, Bonne O, Canetti L
Department of Psychiatry, Hadassah Hebrew University Medical Center, Jerusalem, Israel.
Department of Health Systems Management, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
BMJ Open. 2017 Mar 20;7(3):e014153. doi: 10.1136/bmjopen-2016-014153.
Psychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists and to understand whether awareness of DP correlated with defensive behaviours.
A questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims.
Forty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved in malpractice claims, while 132 (62.1%) participants admitted to practising DP. Residents acknowledged the practice of DP more than did senior psychiatrists (p=0.038).Awareness of DP correlated with unnecessary hospitalisation of suicidal patients, increased unnecessary follow-up visits and prescribing smaller drug dosages than required for pregnant women and elderly patients.
This study provides evidence that DP is well established in the routine clinical daily practice of psychiatrists. Further studies are needed to reveal whether DP effectively protects psychiatrists from malpractice suits or, rather, if it impedes providing quality psychiatric care and represents an economic burden that leads to more harm for the patient.
精神病学是一个低风险的专业领域；然而，针对精神科医生的医疗事故索赔却在稳步增加。防御性精神病学（DP）是指精神科医生采取的任何并非 solely为了患者心理健康和福祉而避免医疗事故责任的行为。本研究的目的是评估精神科医生实施DP的范围，并了解对DP的认知是否与防御行为相关。
在2015年5月和6月，对213名以色列精神科住院医师和执业精神科医生进行了问卷调查，内容涉及人口统计学数据以及医疗事故索赔、法医学文献和诉讼方面的经历。四种临床情景代表了对医疗事故索赔的防御行为及反应（感受和行动）。
44名（20.6%）执业精神科医生和4名（1.9%）住院医师直接涉及医疗事故索赔，而132名（62.1%）参与者承认实施过DP。住院医师比资深精神科医生更认可DP的做法（p = 0.038）。对DP的认知与对自杀患者的不必要住院、增加不必要的随访以及给孕妇和老年患者开低于所需剂量的药物有关。
本研究提供了证据表明DP在精神科医生的日常临床实践中已根深蒂固。需要进一步研究以揭示DP是有效地保护精神科医生免受医疗事故诉讼，还是相反，它是否阻碍了提供高质量的精神科护理并代表一种经济负担，从而对患者造成更多伤害。
