Tumelty Mary-Elizabeth, Cinnamond Kaitlyn, Hannigan Ailish, Tierney Sean, Spain Eimear
School of Law, University College Cork College Road, Cork T12 K8AF Ireland.
Graduate Entry Medical School, University of Limerick Garraun, Castletroy, Co. Limerick, V94 T9PX Ireland.
Eur J Health Law. 2021 Oct 28:1-18. doi: 10.1163/15718093-bja10056.
Defensive medicine describes behaviours engaged in by physicians, for the purposes of averting the threat of medical negligence litigation and/or complaints. Defensive practice typically encompasses 'assurance' or 'avoidance' behaviours, or 'positive' or 'negative' defensive medicine. Assurance behaviours include, for example, meticulous notetaking and ordering further clinically unnecessary tests, whereas avoidance behaviours encompass actions such as refusing to engage with a patient perceived to be high-risk. Whilst such practices may be understandable, defensive medicine is problematic for a number of reasons: it may result in a lower standard of patient care, where for example, a patient is exposed to unnecessary risk(s); and it can increase healthcare costs, which in turn limits resources. Drawing on the findings of a survey of surgeons in Ireland, this study investigates the existence of defensive practices, and explores the impact of the civil and regulatory responses to patient safety incidents on surgical practice. Given the increasing emphasis on patient safety and cultivating a "no-blame" culture both nationally and internationally, the findings of this research illustrate the tension between the current medico-legal and regulatory environment and medical practice, with implications for quality and safety.
防御性医疗描述了医生为避免医疗过失诉讼和/或投诉的威胁而采取的行为。防御性医疗行为通常包括“保障”或“规避”行为，即“积极”或“消极”防御性医疗。保障行为包括，例如，细致的记录和开具更多临床上不必要的检查，而规避行为则包括诸如拒绝诊治被认为是高风险患者等行为。虽然这些做法可能是可以理解的，但防御性医疗存在诸多问题：它可能导致患者护理标准降低，例如，患者面临不必要的风险；而且它会增加医疗成本，进而限制医疗资源。本研究借鉴了一项针对爱尔兰外科医生的调查结果，调查防御性医疗行为的存在情况，并探讨民事和监管部门对患者安全事件的应对措施对手术医疗行为的影响。鉴于国内外对患者安全的日益重视以及培育“无过错”文化，本研究结果揭示了当前医疗法律和监管环境与医疗行为之间的矛盾，这对医疗质量和安全产生了影响。
