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Defensive Medicine

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1. Defensive medicine among antibiotic stewards: the international ESCMID AntibioLegalMap survey. (PubMed)

Defensive medicine among antibiotic stewards: the international ESCMID AntibioLegalMap survey. To investigate fear of legal claims and defensive behaviours among specialists in infectious diseases (ID) and clinical microbiology (CM) and to identify associated demographic and professional characteristics.AntibioLegalMap was an international cross-sectional internet-based survey targeting specialists in ID and CM. Three variables were explored: fear of legal liability in antibiotic prescribing (...) liability. Similarly, 76.4% (505/661) reported defensive behaviours in advising. These behaviours were associated with being sometimes or often worried about liability. The preferred measures to reduce fear and defensive behaviours were having local guidelines and sharing decisions through teamwork.A significant proportion of specialists in ID and CM reported some form of defensive behaviour in prescribing or advising to prescribe antibiotics. Defensive medicine should be considered when implementing

2018 Journal of Antimicrobial Chemotherapy

2. The attitudes towards defensive medicine among physicians of obstetrics and gynaecology in China: a questionnaire survey in a national congress. (PubMed)

The attitudes towards defensive medicine among physicians of obstetrics and gynaecology in China: a questionnaire survey in a national congress. The study aimed to determine prevalence, patterns and risk factors of defensive medicine by obstetricians and gynaecologists across China.This is a questionnaire survey by written and on-line interview for participants.Among 1804 registered physicians participating at the 2017 Congress of Chinese Obstetricians and Gynecologists Association in Chengdu (...) %) participants had witnessed their colleagues exposed to medical disputes, lawsuits or loss of a lawsuit. Generally, 62.9% of the participants strongly agreed or agreed with defensive medicine. Gender, administration duty, employment hospital, education status, subspecialty, exposure to any medical disputes, lawsuits or loss of a lawsuit, and colleagues' experiences were independent risk factors relevant to participants' preferences about defensive medicine in a multivariate model. Participants were more

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2018 BMJ open

3. From Defensive Medicine to Quaternary Prevention: The Transition That Pakistan Needs (PubMed)

From Defensive Medicine to Quaternary Prevention: The Transition That Pakistan Needs The issue of overprescribing laboratory investigations is an old one in the world of medical practice and it has unfortunately seen a tremendous increase with the digitalisation of medicine, in more recent times. Phrased usually as 'defensive medicine,' this kind of overmedicalisation steers medical practice away from the ethical, skill-refining fronts on the part of doctors and imposes an unnecessary financial (...) investigations they choose. The issue is a grave one and its rampancy demands that attention is drawn to it and efforts are made to transition into the practice of evidence-based medicine and quaternary prevention.

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2018 Cureus

4. Defensive medicine: It is time to finally slow down an epidemic (PubMed)

Defensive medicine: It is time to finally slow down an epidemic Defensive medicine is widespread and practiced the world over, with serious consequences for patients, doctors, and healthcare costs. Even students and residents are exposed to defensive medicine practices and taught to take malpractice liability into consideration when making clinical decisions. Defensive medicine is generally thought to stem from physicians' perception that they can easily be sued by patients or their relatives (...) who seek compensation for presumed medical errors. However, in our view the growth of defensive medicine should be seen in the context of larger changes in the conception of medicine that have taken place in the last few decades, undermining the patient-physician trust, which has traditionally been the main source of professional satisfaction for physicians. These changes include the following: time directly spent with patients has been overtaken by time devoted to electronic health records

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2018 World journal of clinical cases

5. Perception of Resources Spent on Defensive Medicine and History of Being Sued Among Hospitalists: Results from a National Survey. (PubMed)

Perception of Resources Spent on Defensive Medicine and History of Being Sued Among Hospitalists: Results from a National Survey. The United States spends substantially more per capita for healthcare than any other nation. Defensive medicine is 1 source of such spending, but its extent is unclear. Using a national survey of approximately 1500 US hospitalists, we report the estimates the US hospitalists provided of the percent of resources spent on defensive medicine and correlates (...) of their estimates. We also ascertained how many reported being sued. Sixty-eight percent of eligible recipients responded. Overall, respondents estimated that 37.5% of healthcare costs are due to defensive medicine. Just over 25% of our respondents, including 55% of those in practice for 20 years or more, reported being sued for medical malpractice. Veterans Affairs (VA) hospital affiliation, more years practicing as a physician, being male, and being a non-Hispanic white individual were all independently

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2017 Journal of Hospital Medicine

6. Myth, Manners, and Medical Ritual: Defensive Medicine and the Fetish of Antibiotics. (PubMed)

Myth, Manners, and Medical Ritual: Defensive Medicine and the Fetish of Antibiotics. Given the global crisis of antimicrobial resistance, the continued misuse of antibiotics is perplexing, particularly despite persistent attempts to curb usage. This issue extends beyond traditional "wastage" areas, of livestock and community medicine, to hospitals, raising questions regarding the current principles of hospital practice. Drawing on five focus group discussions, we explore why doctors act (...) in the ways they do regarding antibiotics, revealing how practices are done, justified, and perpetuated. We posit that antibiotic misuse is better understood in terms of social relations of fear, survival and a desire for autonomy; everyday rituals, performances, and forms of professional etiquette; and the mixed obligations evident in the health sector. Moreover, that antibiotic misuse presents as a case study of the broader problematic of defensive medicine. We argue that the impending global antibiotic

2017 Qualitative Health Research

7. How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners. (PubMed)

How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners. Recent years have witnessed a progressive increase in defensive medicine (DM) in several Western welfare countries. In Danish primary and secondary care, documentation on the extent of DM is lacking. Before investigating the extent of DM, we wanted to explore how the phenomenon is understood and experienced in the context of general practice (...) medical actions, carried out mainly because of external demands that run counter to the GP's professionalism. Several sources of pressure to act defensively were identified by the GPs: the system's pressure to meet external regulations, demands from consumerist patients and a culture among GPs and peers of infallibility and zero-risk tolerance.GPs understand DM as unnecessary and meaningless actions driven by external demands instead of a focus on the patient's problem. GPs consider defensive actions

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2017 BMJ open

8. In defense of forbidden words and evidence-based medicine

In defense of forbidden words and evidence-based medicine The AFP Community Blog: In defense of forbidden words and evidence-based medicine | Monday, December 18, 2017 - Kenny Lin, MD, MPH I was a federal employee in the Department of Health and Human Services (HHS) during the George W. Bush and Obama administrations. Although the current era of "fake news" and "alternative facts" lay in the future, some subjects were inherently more sensitive than others, depending on which party controlled (...) Academy of Family Physicians, which represents 129,000 family physicians and medical students, is both surprised and concerned by the Administration’s clear disregard for the importance of science and evidence-based medicine. ... This action is an obvious attempt to politicize the most fundamental tenets of medicine and research, which will have a chilling effect on the CDC’s ability to rely on science to justify the work it does to protect public health. American Family Physician is editorially

2017 The AFP Community Blog

9. Please call me doctor: In defense of feminist medicine

Please call me doctor: In defense of feminist medicine Please call me doctor: In defense of feminist medicine Please call me doctor: In defense of feminist medicine | | April 14, 2017 151 Shares One stunning afternoon I walked into a patient’s room to discuss our plan, informing her that the nurse would come to draw blood. “You can draw my blood, Miss,” said the male family member sitting in a corner of the room, as far from the patient as possible, his legs crossed, smirking, “We can go (...) , and a delivery that is world class." Related Posts More in Physician < Previous post Next post > Find jobs at Careers by KevinMD.com Search thousands of physician, PA, NP, and CRNA jobs now. × Please call me doctor: In defense of feminist medicine 3 comments Comments are moderated before they are published. Please read the . Leave a Comment Name Email Website Comment Close X Most Popular Past Week | | | | | | Past 6 Months | | | | | | Recent Posts | | | | | | Founded in 2004 by , KevinMD.com is the web’s

2017 KevinMD blog

10. Cytotoxicity of the Defensive Secretion from the Medicinal Insect Blaps rynchopetera (PubMed)

Cytotoxicity of the Defensive Secretion from the Medicinal Insect Blaps rynchopetera Blaps rynchopetera Fairmaire has long been used as a folk medicine by the Yi and Bai ethnic groups in China to treat fever, cough, gastritis, boils, and tumors. In the present study, the cytotoxicity of the defensive secretion (TDS) of B. rynchopetera against AGS Caco-2, HepG2 U251 and Bel-7402 was tested, and the results revealed that TDS had potent cytotoxicity against testing cells with IC50 values of 45.8

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2017 Molecules : A Journal of Synthetic Chemistry and Natural Product Chemistry

11. Bad Medicine: Defensiveness (PubMed)

Bad Medicine: Defensiveness 28546409 2018 07 02 2018 07 02 1478-5242 67 659 2017 06 The British journal of general practice : the journal of the Royal College of General Practitioners Br J Gen Pract Bad Medicine: Defensiveness. 272 10.3399/bjgp17X691217 Spence Des D Maryhill Health Centre, Glasgow. eng Journal Article England Br J Gen Pract 9005323 0960-1643 Br J Gen Pract. 2017 Aug;67(661):348 28751333 2017 5 27 6 0 2017 5 27 6 0 2017 5 27 6 1 ppublish 28546409 67/659/272 10.3399/bjgp17X691217

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2017 The British Journal of General Practice

12. Bad Medicine: Defensiveness (PubMed)

Bad Medicine: Defensiveness 28751333 2017 11 09 2018 12 02 1478-5242 67 661 2017 08 The British journal of general practice : the journal of the Royal College of General Practitioners Br J Gen Pract Bad Medicine: Defensiveness. 348 10.3399/bjgp17X691817 French Fiona F Retired, Aberdeen. E-mail: fionahfrench@hotmail.com. eng Letter Comment England Br J Gen Pract 9005323 0960-1643 0 Antidepressive Agents 12794-10-4 Benzodiazepines IM Br J Gen Pract. 2017 Jun;67(659):272 28546409 Antidepressive (...) Agents adverse effects Benzodiazepines adverse effects Humans Practice Patterns, Physicians' State Medicine United Kingdom 2017 7 29 6 0 2017 7 29 6 0 2017 11 10 6 0 ppublish 28751333 67/661/348-a 10.3399/bjgp17X691817 PMC5519103 Br J Gen Pract. 2017 Jun;67(659):272 28546409

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2017 The British Journal of General Practice

13. Defensive medicine among neurosurgeons in the Netherlands: a national survey (PubMed)

Defensive medicine among neurosurgeons in the Netherlands: a national survey In defensive medicine, practice is motivated by legal rather than medical reasons. Previous studies have analyzed the correlation between perceived medico-legal risk and defensive behavior among neurosurgeons in the United States, Canada, and South Africa, but not yet in Europe. The aim of this study is to explore perceived liability burdens and self-reported defensive behaviors among neurosurgeons in the Netherlands (...) and compare their practices with their non-European counterparts.A survey was sent to 136 neurosurgeons. The survey included questions from several domains: surgeon characteristics, patient demographics, type of practice, surgeon liability profile, policy coverage, defensive practices, and perception of the liability environment. Survey responses were analyzed and summarized.Forty-five neurosurgeons filled out the questionnaire (response rate of 33.1%). Almost half (n = 20) reported paying less than 5

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2017 Acta neurochirurgica

14. Damage caps and defensive medicine, revisited. (PubMed)

Damage caps and defensive medicine, revisited. Does tort reform reduce defensive medicine and thus healthcare spending? Several (though not all) prior studies, using a difference-in-differences (DiD) approach, find lower Medicare spending for hospital care after states adopt caps on non-economic or total damages ("damage caps"), during the "second" reform wave of the mid-1980s. We re-examine this issue in several ways. We study the nine states that adopted caps during the "third reform wave

2016 Journal of health economics

15. Defensive Medicine in U.S. Spine Neurosurgery. (PubMed)

Defensive Medicine in U.S. Spine Neurosurgery. Observational cross-sectional survey.To compare defensive practices of U.S. spine and nonspine neurosurgeons in the context of state medical liability risk.Defensive medicine is a commonly reported and costly phenomenon in neurosurgery. Although state liability risk is thought to contribute greatly to defensive practice, variation within neurosurgical specialties has not been well explored.A validated, online survey was sent via email to 3344 (...) environment is not a significant driver of increased defensive medicine associated with neurosurgical spine procedures.3.

2016 Spine

16. The Ecology of Defensive Medicine and Malpractice Litigation (PubMed)

The Ecology of Defensive Medicine and Malpractice Litigation Using an evolutionary game, we show that patients and physicians can interact with predator-prey relationships. Litigious patients who seek compensation are the 'predators' and physicians are their 'prey'. Physicians can adapt to the risk of being sued by performing defensive medicine. We find that improvements in clinical safety can increase the share of litigious patients and leave unchanged the share of physicians who perform (...) defensive medicine. This paradoxical result is consistent with increasing trends in malpractice claims in spite of safety improvements, observed for example in empirical studies on anesthesiologists. Perfect cooperation with neither defensive nor litigious behaviors can be the Pareto-optimal solution when it is not a Nash equilibrium, so maximizing social welfare may require government intervention.

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2016 PloS one

17. Defensive Medicine

Defensive Medicine Defensive Medicine Toggle navigation Brain Head & Neck Chest Endocrine Abdomen Musculoskeletal Skin Infectious Disease Hematology & Oncology Cohorts Diagnostics Emergency Findings Procedures Prevention & Management Pharmacy Resuscitation Trauma Emergency Procedures Ultrasound Cardiovascular Emergencies Lung Emergencies Infectious Disease Pediatrics Neurologic Emergencies Skin Exposure Miscellaneous Abuse Cancer Administration 4 Defensive Medicine Defensive Medicine Aka (...) : Defensive Medicine II. Definitions Defensive Medicine Deviation from evidence-based medical decisions due to liability threat Example: Ordering advanced imaging (e.g. ) despite reassuring decision rules (e.g. ) Sub-types of Defensive Medicine Assurance behavior Additional services offered that add little medical value Avoidance behavior Replacing care by referring to another medical provider Reducing care by refusing to treat a patient III. Epidemiology Defensive Medicine is practiced by a majority

2018 FP Notebook

18. Concept of defensive medicine and litigation among Sudanese doctors working in obstetrics and gynecology (PubMed)

Concept of defensive medicine and litigation among Sudanese doctors working in obstetrics and gynecology Obstetrics and gynaecology always has reputation for being a highly litigious. The field of obstetrics and gynaecology is surrounded by different circumstances that stimulate the doctors to practice defensive medicine.This study was directed to assess the extent and the possible effect of defensive medicine phenomenon (in term of knowledge and prevalence) on medical decision making among (...) % had the impression that litigation against doctors are increasing and 27.6% had a direct experience of litigation. In this study less than one half (42.7%) of the surveyed doctors knew the concept of defensive medicine and 71.8% reported practicing one or another form of defensive medicine. The different sources of the litigations reported by the doctors included: maternal death (n = 15), perinatal death (n = 5), other {misdiagnosis, intra-uterine fetal death, uterine perforation, rupture uterus

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2016 BMC medical ethics

19. In the pages of Nature, a full-throated defense of “integrating” quackery into medicine

In the pages of Nature, a full-throated defense of “integrating” quackery into medicine In the pages of Nature, a full-throated defense of "integrating" quackery into medicine | ScienceBlogs Advertisment Search Search Toggle navigation Main navigation In the pages of Nature, a full-throated defense of "integrating" quackery into medicine By on October 15, 2015. Oh, no, Nature . Not you. Not again. It wasn't enough that you were with a big, glossy advertising supplement a few years ago. I (...) thought you had learned your lesson after that, as you didn't do it again. Maybe I was wrong. Granted, your offense this time is not quite as bad as accepting cash from Saishunkan Pharmaceutical Co., ltd. and the Kitasato University Oriental Medicine Research Center to put together what was in essence pure propaganda for quackery, but, on the other hand, I do have to be worried that you might be thinking of backsliding, of moving that way again. What else am I supposed to think when I see a defense

2015 Respectful Insolence

20. Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus. (PubMed)

Synopsis of the 2017 U.S. Department of Veterans Affairs/U.S. Department of Defense Clinical Practice Guideline: Management of Type 2 Diabetes Mellitus. In April 2017, the U.S. Department of Veterans Affairs (VA) and the U.S. Department of Defense (DoD) approved a joint clinical practice guideline for the management of type 2 diabetes mellitus.The VA/DoD Evidence-Based Practice Work Group convened a joint VA/DoD guideline development effort that included a multidisciplinary panel of practicing (...) clinician stakeholders and conformed to the Institute of Medicine's tenets for trustworthy clinical practice guidelines. The guideline panel developed key questions in collaboration with the ECRI Institute, which systematically searched and evaluated the literature through June 2016, developed an algorithm, and rated recommendations by using the GRADE (Grading of Recommendations Assessment, Development and Evaluation) system.This synopsis summarizes key features of the guideline in 7 areas: patient

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2017 Annals of Internal Medicine

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