Olcay Ayhan, Emren Sadık Volkan, Babür Güler Gamze, Güler Ekrem, Ertunç Vedat, Berilgen Rida, Aslan Abdullah, Şimşek Ersin Çağrı, Gölcük Şükriye Ebru, Yalın Kıvanç
Department of Cardiology, İstanbul Aydın University Faculty of Medicine, İstanbul, Turkey.
Turk Kardiyol Dern Ars. 2017 Oct;45(7):630-637. doi: 10.5543/tkda.2017.39455.
Cardiologists participate in the diagnosis and interventional treatment of numerous high-risk patients. The goal of this study was to investigate how the current malpractice system in Turkey influences cardiologists' diagnostic and interventional behavior and to obtain their opinions about an alternative patient compensation system.
The present cross-sectional study assessed the practice of defensive medicine among cardiologists who are actively working in various types of workplace within the Turkish healthcare system. A 24-item questionnaire was distributed to cardiology residents, specialists, and academics in Turkey in print format, by electronic mail, or via cell phone message.
A total of 253 cardiologists responded to the survey. Among them, 29 (11.6%) had been sued for malpractice claims in the past. Of the cardiologists who had been sued, 2 (6.9%) had been ordered to pay financial compensation, and 1 (3.4%) was given a sentence of imprisonment due to negligence. In all, 132 (52.8%) of the surveyed cardiologists reported that they had changed their practices due to fear of litigation, and 232 (92.8%) reported that they would prefer the new proposed patient compensation system to the current malpractice system. Among the cardiologists surveyed, 78.8% indicated that malpractice fear had affected their decision-making with regard to requesting computed tomography angiography or thallium scintigraphy, 71.6% for coronary angiography, 20% for stent implantation, and 83.2% for avoiding treating high-risk patients.
The results of this survey demonstrated that cardiologists may request unnecessary tests and perform unneeded interventions due to the fear of malpractice litigation fear. Many also avoid high-risk patients and interventions. The majority indicated that they would prefer the proposed alternative patient compensation system to the current malpractice system.
心脏病专家参与众多高危患者的诊断和介入治疗。本研究的目的是调查土耳其现行的医疗事故制度如何影响心脏病专家的诊断和介入行为，并获取他们对替代患者赔偿制度的看法。
本横断面研究评估了在土耳其医疗系统内各类工作场所积极工作的心脏病专家的防御性医疗行为。通过印刷形式、电子邮件或手机短信向土耳其的心脏病学住院医师、专家和学者发放了一份包含24个条目的问卷。
共有253名心脏病专家回复了调查。其中，29名（11.6%）过去曾因医疗事故索赔被起诉。在被起诉的心脏病专家中，2名（6.9%）被责令支付经济赔偿，1名（3.4%）因疏忽被判处监禁。总体而言，132名（52.8%）参与调查的心脏病专家报告称，由于担心诉讼，他们改变了自己的诊疗行为，232名（92.8%）报告称，相较于现行的医疗事故制度，他们更喜欢新提议的患者赔偿制度。在参与调查的心脏病专家中，78.8%表示医疗事故恐惧影响了他们在要求进行计算机断层扫描血管造影或铊闪烁扫描方面的决策，71.6%表示影响了冠状动脉造影的决策，20%表示影响了支架植入的决策，83.2%表示影响了避免治疗高危患者的决策。
本次调查结果表明，由于担心医疗事故诉讼，心脏病专家可能会要求进行不必要的检查并实施不必要的干预。许多人还会回避高危患者和干预措施。大多数人表示，相较于现行的医疗事故制度，他们更喜欢提议的替代患者赔偿制度。
