What is meant by the term “defensive medicine”?

1. Guthorn PJ. Toward a defensive stance in medical practice. J Med Soc N J 1968;65:548–9. [PubMed] [Google Scholar]

2. Garcia-Retamero R, Galesic M. On defensive decision making: how doctors make decisions for their patients. Health Expect 2014;17:664–9. 10.1111/j.1369-7625.2012.00791.x [PMC free article] [PubMed] [CrossRef] [Google Scholar]

3. Panella M, Rinaldi C, Leigheb F, et al.. Prevalence and costs of defensive medicine: a national survey of Italian physicians. J Health Serv Res Policy 2017;22:211–7. 10.1177/1355819617707224 [PubMed] [CrossRef] [Google Scholar]

4. Brateanu A, Schramm S, Hu B, et al.. Quantifying the defensive medicine contribution to primary care costs. J Med Econ 2014;17:810–16. 10.3111/13696998.2014.959125 [PubMed] [CrossRef] [Google Scholar]

5. Bourne T, Wynants L, Peters M, et al.. The impact of complaints procedures on the welfare, health and clinical practise of 7926 doctors in the UK: a cross-sectional survey. BMJ Open 2015;5:e006687. 10.1136/bmjopen-2014-006687 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

6. Catino M, Celotti S. The problem of defensive medicine: two Italian surveys. Stud Health Technol Inform 2009;148:206–21. [PubMed] [Google Scholar]

7. Assing Hvidt E, Lykkegaard J, Pedersen LB, et al.. How is defensive medicine understood and experienced in a primary care setting? A qualitative focus group study among Danish general practitioners. BMJ Open 2017;7:e019851. 10.1136/bmjopen-2017-019851 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

8. Assing Hvidt E, Bjørnskov Pedersen L, Lykkegaard J, et al.. A colonized general practice? A critical habermasian analysis of how general practitioners experience defensive medicine in their everyday working life. Health 2019;25:141–58. 10.1177/1363459319857461 [PubMed] [CrossRef] [Google Scholar]

9. Corrigan J, Wagner J, Wolfe L, et al.. Medical malpractice reform and defensive medicine. Cancer Invest 1996;14:277–84. 10.3109/07357909609012149 [PubMed] [CrossRef] [Google Scholar]

10. OTA . Office of technology assessment. defensive medicine and medical malpractice. Washington (dC). Available: http://ota.fas.org/reports/9405.pdf.1994(PublicationNo.OTA-H-602) [Accessed July 2019].

11. Hershey N. The defensive practice of medicine. Myth or reality. The Milbank Memorial Fund quarterly 1972;50:69–98. [PubMed] [Google Scholar]

12. Studdert DM, Mello MM, Sage WM, et al.. Defensive medicine among high-risk specialist physicians in a volatile malpractice environment. JAMA 2005;293:2609–17. 10.1001/jama.293.21.2609 [PubMed] [CrossRef] [Google Scholar]

13. Investopedia. Available: https://www.investopedia.com/terms/m/malpractice-insurance.asp [Accessed 15th December 2020].

14. Jena AB, Schoemaker L, Bhattacharya J, et al.. Physician spending and subsequent risk of malpractice claims: observational study. BMJ 2015;351:h5516. 10.1136/bmj.h5516 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

15. Veldhuis M. Defensive behavior of Dutch family physicians. Widening the concept. Family Medicine 1994;26:27–9. [PubMed] [Google Scholar]

16. Van Boven K, Dijksterhuis P, Lamberts H. Defensive testing in Dutch family practice. is the grass greener on the other side of the ocean? J Fam Pract 1997;44:468–72. [PubMed] [Google Scholar]

17. Rohacek M, Buatsi J, Szucs-Farkas Z, et al.. Ordering CT pulmonary angiography to exclude pulmonary embolism: defense versus evidence in the emergency room. Intensive Care Med 2012;38:1345–51. 10.1007/s00134-012-2595-z [PubMed] [CrossRef] [Google Scholar]

18. Steurer J, Held U, Schmidt M, et al.. Legal concerns trigger prostate-specific antigen testing. J Eval Clin Pract 2009;15:390–2. 10.1111/j.1365-2753.2008.01024.x [PubMed] [CrossRef] [Google Scholar]

19. Antoci A, Fiori Maccioni A, Russu P. The ecology of defensive medicine and malpractice litigation. PLoS One 2016;11:e0150523. 10.1371/journal.pone.0150523 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

20. Yan SC, Hulsbergen AFC, Muskens IS, et al.. Defensive medicine among neurosurgeons in the Netherlands: a national survey. Acta Neurochir 2017;159:2341–50. 10.1007/s00701-017-3323-9 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

21. Kessler DP, Summerton N, Graham JR. Effects of the medical liability system in Australia, the UK, and the USA. Lancet 2006;368:240–6. 10.1016/S0140-6736(06)69045-4 [PubMed] [CrossRef] [Google Scholar]

22. Summerton N. Trends in negative defensive medicine within general practice. Br J Gen Pract 2000;50:565–6. [PMC free article] [PubMed] [Google Scholar]

23. Vandersteegen T, Marneffe W, Cleemput I, et al.. The determinants of defensive medicine practices in Belgium. Health Econ Policy Law 2017;12:363–86. 10.1017/S174413311600030X [PubMed] [CrossRef] [Google Scholar]

24. Brilla R, Evers S, Deutschländer A, et al.. Are neurology residents in the United States being taught defensive medicine? Clin Neurol Neurosurg 2006;108:374–7. 10.1016/j.clineuro.2005.05.013 [PubMed] [CrossRef] [Google Scholar]

25. Ramella S, Mandoliti G, Trodella L, et al.. The first survey on defensive medicine in radiation oncology. Radiol Med 2015;120:421–9. 10.1007/s11547-014-0465-1 [PubMed] [CrossRef] [Google Scholar]

26. Page MJ, McKenzie JE, Bossuyt PM, et al.. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. J Clin Epidemiol 2021;134:178–89. 10.1016/j.jclinepi.2021.03.001 [PubMed] [CrossRef] [Google Scholar]

27. EndNote. Available: https://endnote.com [Accessed July 2019].

28. Covidence. Available: https://www.covidence.org/reviews [Accessed July 2019].

29. WebOfScience. Available: https://login.webofknowledge.com/error/Error?Error=IPError&PathInfo=%2F&RouterURL=https%3A%2F%2Fwww.webofknowledge.com%2F&Domain=.webofknowledge.com&Src=IP&Alias=WOK5 [Accessed May 2021].

30. Mikkonen KKM. Content Analysis in Systematic Reviews. In: Kyngäs H, Mikkonen K, Kääriäinen M, eds. The application of content analysis in nursing science research Cham. Springer International Publishing, 2020: 105–15. [Google Scholar]

31. CASP . Critical appraisal skills programme (2018). CASP (qualitative) checklist. Available: https://casp-uk.net/wp-content/uploads/2018/01/CASP-Qualitative-Checklist-2018.pdf [Accessed July 2019].

32. Guyatt GH, Cook DJ. Users’ Guides to the Medical Literature. JAMA 1994;271:59–63. 10.1001/jama.1994.03510250075039 [PubMed] [CrossRef] [Google Scholar]

33. Guyatt GH, Sackett DL, Cook DJ. Users' guides to the medical literature. II. How to use an article about therapy or prevention. B. what were the results and will they help me in caring for my patients? evidence-based medicine Working group. JAMA 1993;270:2598–601. 10.1001/jama.271.1.59 [PubMed] [CrossRef] [Google Scholar]

34. Bourne T, De Cock B, Wynants L, et al.. Doctors' perception of support and the processes involved in complaints investigations and how these relate to welfare and defensive practice: a cross-sectional survey of the UK physicians. BMJ Open 2017;7:e017856. 10.1136/bmjopen-2017-017856 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

35. Bourne T, Shah H, Falconieri N, et al.. Burnout, well-being and defensive medical practice among obstetricians and gynaecologists in the UK: cross-sectional survey study. BMJ Open 2019;9:e030968. 10.1136/bmjopen-2019-030968 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

36. Bourne T, Vanderhaegen J, Vranken R, et al.. Doctors' experiences and their perception of the most stressful aspects of complaints processes in the UK: an analysis of qualitative survey data. BMJ Open 2016;6:e011711. 10.1136/bmjopen-2016-011711 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

37. Domingues AP, Moura P, Vieira DN. Lessons from a decade of technical-scientific opinions in obstetrical litigation. J Forensic Leg Med 2014;25:91–4. 10.1016/j.jflm.2014.04.012 [PubMed] [CrossRef] [Google Scholar]

38. Elli L, Tenca A, Soncini M, et al.. Defensive medicine practices among Gastroenterologists in Lombardy: between lawsuits and the economic crisis. Dig Liver Dis 2013;45:469–73. 10.1016/j.dld.2013.01.004 [PubMed] [CrossRef] [Google Scholar]

39. Feess E, liability M. Malpractice liability, technology choice and negative defensive medicine. Eur J Health Econ 2012;13:157–67. 10.1007/s10198-010-0294-7 [PubMed] [CrossRef] [Google Scholar]

40. Küçük M. Defensive medicine among obstetricians and gynaecologists in turkey. J Obstet Gynaecol 2018;38:200–5. 10.1080/01443615.2017.1340933 [PubMed] [CrossRef] [Google Scholar]

41. Laarman BS, Bouwman RJ, de Veer AJ, et al.. How do doctors in the Netherlands perceive the impact of disciplinary procedures and disclosure of disciplinary measures on their professional practice, health and career opportunities? A questionnaire among medical doctors who received a disciplinary measure. BMJ Open 2019;9:e023576. 10.1136/bmjopen-2018-023576 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

42. Lindenthal JJ, Lako CJ, van der Waal MA, et al.. Quality and cost of healthcare: a cross-national comparison of American and Dutch attitudes. Am J Manag Care 1999;5:173–81. [PubMed] [Google Scholar]

43. Litchfield IJ, Lilford RJ, Bentham LM, et al.. A qualitative exploration of the motives behind the decision to order a liver function test in primary care. Qual Prim Care 2014;22:201–10. [PubMed] [Google Scholar]

44. Motta S, Testa D, Cesari U, et al.. Medical liability, defensive medicine and professional insurance in otolaryngology. BMC Res Notes 2015;8:343. 10.1186/s13104-015-1318-2 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

45. Olcay A, Emren SV, Babür Güler G, et al.. The opinion of Turkish cardiologists on current malpractice system and an alternative patient compensation system proposal: PCS Study Group. Turk Kardiyol Dern Ars 2017;45:630–7. 10.5543/tkda.2017.39455 [PubMed] [CrossRef] [Google Scholar]

46. Ortashi O, Virdee J, Hassan R, et al.. The practice of defensive medicine among hospital doctors in the United Kingdom. BMC Med Ethics 2013;14:42. 10.1186/1472-6939-14-42 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

47. Osti M, Steyrer J. A national survey of defensive medicine among orthopaedic surgeons, trauma surgeons and radiologists in Austria: evaluation of prevalence and context. J Eval Clin Pract 2015;21:278–84. 10.1111/jep.12305 [PubMed] [CrossRef] [Google Scholar]

48. Panella M, Rinaldi C, Leigheb F, et al.. The determinants of defensive medicine in Italian hospitals: the impact of being a second victim. Rev Calid Asist 2016;31 Suppl 2:20–5. 10.1016/j.cali.2016.04.010 [PubMed] [CrossRef] [Google Scholar]

49. Passmore K, Leung W-C. Defensive practice among psychiatrists: a questionnaire survey. Postgrad Med J 2002;78:671–3. 10.1136/pmj.78.925.671 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

50. Renkema E, Broekhuis M, Ahaus K. Conditions that influence the impact of malpractice litigation risk on physicians' behavior regarding patient safety. BMC Health Serv Res 2014;14:38. 10.1186/1472-6963-14-38 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

51. Solaroglu I, Izci Y, Yeter HG, et al.. Health transformation project and defensive medicine practice among neurosurgeons in turkey. PLoS One 2014;9:e111446. 10.1371/journal.pone.0111446 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

52. Summerton N. Positive and negative factors in defensive medicine: a questionnaire study of general practitioners. BMJ 1995;310:27–9. 10.1136/bmj.310.6971.27 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

53. Symon A. Litigation and changes in professional behaviour: a qualitative appraisal. Midwifery 2000;16:15–21. 10.1054/midw.1999.0193 [PubMed] [CrossRef] [Google Scholar]

54. Symon A. Litigation and defensive clinical practice: quantifying the problem. Midwifery 2000;16:8–14. 10.1054/midw.1999.0181 [PubMed] [CrossRef] [Google Scholar]

55. Tanriverdi O, Cay-Senler F, Yavuzsen T, et al.. Perspectives and practical applications of medical oncologists on defensive medicine (SYSIPHUS study): a study of the palliative care working Committee of the Turkish Oncology Group (TOG). Med Oncol 2015;32. 10.1007/s12032-015-0555-5 [PubMed] [CrossRef] [Google Scholar]

56. Tebano G, Dyar OJ, Beovic B, et al.. Defensive medicine among antibiotic stewards: the International ESCMID AntibioLegalMap survey. J Antimicrob Chemother 2018;73:1989–96. 10.1093/jac/dky098 [PubMed] [CrossRef] [Google Scholar]

57. Vimercati A, Greco P, Kardashi A, et al.. Choice of cesarean section and perception of legal pressure. J Perinat Med 2000;28:111–7. 10.1515/JPM.2000.014 [PubMed] [CrossRef] [Google Scholar]

58. Aranaz Andrés JM, Valencia-Martín JL, Vicente-Guijarro J, et al.. Low-Value clinical practices: knowledge and beliefs of Spanish surgeons and anesthetists. Int J Environ Res Public Health 2020;17. 10.3390/ijerph17103556. [Epub ahead of print: 19 05 2020]. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

59. Calikoglu EO, Aras A. 'Defensive medicine among different surgical disciplines: a descriptive cross-sectional study. J Forensic Leg Med 2020;73:101970. 10.1016/j.jflm.2020.101970 [PubMed] [CrossRef] [Google Scholar]

60. Ferorelli D, Donno F, De Giorgio G, et al.. Head CT scan in emergency room: is it still abused? quantification and causes analysis of Overprescription in an Italian emergency department. Radiol Med 2020;125:595–9. 10.1007/s11547-020-01143-9 [PubMed] [CrossRef] [Google Scholar]

61. Gadjradj PS, Ghobrial JB, Harhangi BS. Experiences of neurological surgeons with malpractice lawsuits. Neurosurg Focus 2020;49:E3. 10.3171/2020.8.FOCUS20250 [PubMed] [CrossRef] [Google Scholar]

62. Müller BS, Donner-Banzhoff N, Beyer M, et al.. Regret among primary care physicians: a survey of diagnostic decisions. BMC Fam Pract 2020;21:53. 10.1186/s12875-020-01125-w [PMC free article] [PubMed] [CrossRef] [Google Scholar]

63. Osorio D, Ribera A, Solans-Domènech M, et al.. Healthcare professionals' opinions, barriers and facilitators towards low-value clinical practices in the hospital setting. Gac Sanit 2020;34:459–67. 10.1016/j.gaceta.2018.11.007 [PubMed] [CrossRef] [Google Scholar]

64. Vargas-Blasco C, Gómez-Durán EL, Martin-Fumadó C, et al.. Medical malpractice liability and its consequences. Actas Urol Esp 2020;44:251–7. 10.1016/j.acuro.2020.01.004 [PubMed] [CrossRef] [Google Scholar]

65. Vizcaino-Rakosnik M, Martin-Fumado C, Arimany-Manso J. The impact of malpractice claims on physicians' well-being and practice. J Patient Saf 2020;14. [PubMed] [Google Scholar]

66. Young B, Fogarty AW, Skelly R, et al.. Hospital doctors' attitudes to brief educational messages that aim to modify diagnostic test requests: a qualitative study. BMC Med Inform Decis Mak 2020;20:80. 10.1186/s12911-020-1087-2 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

67. Mira JJ, Carrillo I, Silvestre C, et al.. Drivers and strategies for avoiding overuse. A cross-sectional study to explore the experience of Spanish primary care providers handling uncertainty and patients' requests. BMJ Open 2018;8:e021339. 10.1136/bmjopen-2017-021339 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

68. Pausch M, Schedlbauer A, Weiss M, et al.. Is it really always only the others who are to blame? GP's view on medical overuse. A questionnaire study. PLoS One 2020;15:e0227457. 10.1371/journal.pone.0227457 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

69. EnglishOxfordLivingDictionaries. Available: https://en.oxforddictionaries.com/definition/definition [Accessed 15th December 2020].

70. Bester JC. Defensive practice is indefensible: how defensive medicine runs counter to the ethical and professional obligations of clinicians. Med Health Care Philos 2020;23:413–20. 10.1007/s11019-020-09950-7 [PubMed] [CrossRef] [Google Scholar]

71. Garattini L, Padula A. Defensive medicine in Europe: a 'full circle'? Eur J Health Econ 2020;21:477–82. 10.1007/s10198-019-01151-1 [PubMed] [CrossRef] [Google Scholar]

72. Laarman BS, Bouwman RJR, de Veer AJE, et al.. Is the perceived impact of disciplinary procedures on medical doctors' professional practice associated with working in an open culture and feeling supported? A questionnaire among medical doctors in the Netherlands who have been disciplined. BMJ Open 2020;10:e036922. 10.1136/bmjopen-2020-036922 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

73. Yan SC, Hulou MM, Cote DJ, et al.. International defensive medicine in neurosurgery: comparison of Canada, South Africa, and the United States. World Neurosurg 2016;95:53–61. 10.1016/j.wneu.2016.07.069 [PubMed] [CrossRef] [Google Scholar]

74. Cunningham W, Dovey S. Defensive changes in medical practice and the complaints process: a qualitative study of new Zealand doctors. N Z Med J 2006;119:U2283. [PubMed] [Google Scholar]

75. Mullen R, Admiraal A, Trevena J. Defensive practice in mental health. N Z Med J 2008;121:85–91. [PubMed] [Google Scholar]

76. Agarwal R, Gupta A, Gupta S. The impact of tort reform on defensive medicine, quality of care, and physician supply: a systematic review. Health Serv Res 2019;54:851–9. 10.1111/1475-6773.13157 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

77. Anderson BL, Strunk AL, Schulkin J. Study on defensive medicine practices among obstetricians and gynecologists who provide breast care. J Healthc Qual 2011;33:37–43. 10.1111/j.1945-1474.2010.00120.x [PubMed] [CrossRef] [Google Scholar]

78. Atanasov P, Anderson BL, Cain J, et al.. Comparing physicians personal prevention practices and their recommendations to patients. J Healthc Qual 2015;37:189–98. 10.1111/jhq.12042 [PubMed] [CrossRef] [Google Scholar]

79. Baicker K, Wright BJ, Olson NA. Reevaluating reports of defensive medicine. J Health Polit Policy Law 2015;40:1157–77. 10.1215/03616878-3424462 [PubMed] [CrossRef] [Google Scholar]

80. Baldwin LM, Hart LG, Lloyd M, et al.. Defensive medicine and obstetrics. JAMA 1995;274:1606–10. 10.1001/jama.1995.03530200042034 [PubMed] [CrossRef] [Google Scholar]

81. Brown HS, activity L. Lawsuit activity, defensive medicine, and small area variation: the case of cesarean sections revisited. Health Econ Policy Law 2007;2:285–96. 10.1017/S1744133107004136 [PubMed] [CrossRef] [Google Scholar]

82. Cano-Urbina J, Montanera D. Do tort reforms impact the incidence of birth by cesarean section? A reassessment. Int J Health Econ Manag 2017;17:103–12. 10.1007/s10754-016-9202-8 [PubMed] [CrossRef] [Google Scholar]

83. Carrier ER, Reschovsky JD, Katz DA, et al.. High physician concern about malpractice risk predicts more aggressive diagnostic testing in office-based practice. Health Aff 2013;32:1383–91. 10.1377/hlthaff.2013.0233 [PubMed] [CrossRef] [Google Scholar]

84. Carrier ER, Reschovsky JD, Mello MM, et al.. Physicians’ Fears Of Malpractice Lawsuits Are Not Assuaged By Tort Reforms. Health Aff 2010;29:1585–92. 10.1377/hlthaff.2010.0135 [PubMed] [CrossRef] [Google Scholar]

85. Chen J, Majercik S, Bledsoe J, et al.. The prevalence and impact of defensive medicine in the radiographic workup of the trauma patient: a pilot study. Am J Surg 2015;210:462–7. 10.1016/j.amjsurg.2015.03.016 [PubMed] [CrossRef] [Google Scholar]

86. Cote DJ, Karhade AV, Larsen AMG, et al.. Neurosurgical defensive medicine in Texas and Illinois: a tale of 2 states. World Neurosurg 2016;89:112–20. 10.1016/j.wneu.2016.01.080 [PubMed] [CrossRef] [Google Scholar]

87. Din RS, Yan SC, Cote DJ. Defensive medicine in U. S. Spine Neurosurgery. Spine 2017;42:177–85. [PubMed] [Google Scholar]

88. Dubay L, Kaestner R, Waidmann T. The impact of malpractice fears on cesarean section rates. J Health Econ 1999;18:491–522. 10.1016/S0167-6296(99)00004-1 [PubMed] [CrossRef] [Google Scholar]

89. Farmer SA, Moghtaderi A, Schilsky S, et al.. Association of medical liability reform with clinician approach to coronary artery disease management. JAMA Cardiol 2018;3:609–18. 10.1001/jamacardio.2018.1360 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

90. Frakes M, Gruber J. Defensive medicine: evidence from military immunity. Am Econ J Econ Policy 2019;11:197–231. 10.1257/pol.20180167 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

91. Garg ML, Gliebe WA, Elkhatib MB. The extent of defensive medicine: some empirical evidence. Leg Aspects Med Pract 1978;6:25–9. [PubMed] [Google Scholar]

92. Gerlach J, Abodunde B, Sollosy M, et al.. Rethinking the obvious: time for new ideas on medical malpractice tort reform. Health Care Manag 2019;38:109–15. 10.1097/HCM.0000000000000260 [PubMed] [CrossRef] [Google Scholar]

93. Glassman PA, Rolph JE, Petersen LP, et al.. Physicians' personal malpractice experiences are not related to defensive clinical practices. J Health Polit Policy Law 1996;21:219–41. 10.1215/03616878-21-2-219 [PubMed] [CrossRef] [Google Scholar]

94. Grant D, McInnes MM. Malpractice experience and the incidence of cesarean delivery: a physician-level longitudinal analysis. Inquiry 2004;41:170–88. 10.5034/inquiryjrnl_41.2.170 [PubMed] [CrossRef] [Google Scholar]

95. Hellinger FJ, Encinosa WE. The impact of state laws limiting malpractice damage awards on health care expenditures. Am J Public Health 2006;96:1375–81. 10.2105/AJPH.2005.077883 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

96. Hooe BS, Thakore RV, Issar N, et al.. Do practice settings influence defensive medicine in orthopedic surgery? Am J Orthop 2014;43:E175–80. [PubMed] [Google Scholar]

97. Jacobson PD, Rosenquist CJ. The use of low-osmolar contrast agents: technological change and defensive medicine. J Health Polit Policy Law 1996;21:243–66. 10.1215/03616878-21-2-243 [PubMed] [CrossRef] [Google Scholar]

98. Jiang ZY, Mhoon E, Saadia-Redleaf M. Medicolegal concerns among neurotologists in ordering MRIs for idiopathic sensorineural hearing loss and asymmetric sensorineural hearing loss. Otol Neurotol 2011;32:403–5. 10.1097/MAO.0b013e31820e6d8d [PubMed] [CrossRef] [Google Scholar]

99. Kavanagh KT, Calderon LE, Saman DM. The relationship between tort reform and medical utilization. J Patient Saf 2014;10:222–30. 10.1097/PTS.0b013e3182a7e992 [PubMed] [CrossRef] [Google Scholar]

100. Kessler DP, McClellan MB. How liability law affects medical productivity. J Health Econ 2002;21:931–55. 10.1016/S0167-6296(02)00076-0 [PubMed] [CrossRef] [Google Scholar]

101. Kim EK, Fletcher WJ, Johnson CT. Effect of increasing malpractice insurance cost and subsequent practice of defensive medicine on out-of-hospital birth rates in the United States. Am J Perinatol 2019;36:723–9. 10.1055/s-0038-1675156 [PubMed] [CrossRef] [Google Scholar]

102. Klingman D, Localio AR, Sugarman J, et al.. Measuring defensive medicine using clinical scenario surveys. J Health Polit Policy Law 1996;21:185–220. 10.1215/03616878-21-2-185 [PubMed] [CrossRef] [Google Scholar]

103. Kravitz RL, Rolph JE, Petersen L. Omission-related malpractice claims and the limits of defensive medicine. Med Care Res Rev 1997;54:456–71. 10.1177/107755879705400404 [PubMed] [CrossRef] [Google Scholar]

104. Langwell KM, Werner JL. Regional variations in the determinants of professional liability claims. J Health Polit Policy Law 1980;5:498–513. 10.1215/03616878-5-3-498 [PubMed] [CrossRef] [Google Scholar]

105. Li S, Brantley E. Malpractice liability risk and use of diagnostic imaging services: a systematic review of the literature. J Am Coll Radiol 2015;12:1403–12. 10.1016/j.jacr.2015.09.015 [PubMed] [CrossRef] [Google Scholar]

106. Li S, Dor A, Deyo D, et al.. The impact of state tort reforms on imaging utilization. J Am Coll Radiol 2017;14:149–56. 10.1016/j.jacr.2016.10.002 [PubMed] [CrossRef] [Google Scholar]

107. MacKenzie CR, Meltzer M, Kitsis EA, et al.. Ethical challenges in rheumatology: a survey of the American College of rheumatology membership. Arthritis Rheum 2013;65:2524–32. 10.1002/art.38077 [PubMed] [CrossRef] [Google Scholar]

108. McCrary SV, Swanson JW, Perkins HS, et al.. Treatment decisions for terminally ill patients: physicians' legal defensiveness and knowledge of medical law. Law Med Health Care 1992;20:364–76. 10.1111/j.1748-720X.1992.tb01217.x [PubMed] [CrossRef] [Google Scholar]

109. Mello MM, Chandra A, Gawande AA, et al.. National costs of the medical liability system. Health Aff 2010;29:1569–77. 10.1377/hlthaff.2009.0807 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

110. Miller RA, Sampson NR, Flynn JM. The prevalence of defensive orthopaedic imaging: a prospective practice audit in Pennsylvania. J Bone Joint Surg Am 2012;94:e18 10.2106/JBJS.K.00646 [PubMed] [CrossRef] [Google Scholar]

111. Moghtaderi A, Farmer S, Black B. Damage caps and defensive medicine: reexamination with patient-level data. J Empir Leg Stud 2019;16:26–68. 10.1111/jels.12208 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

112. Montanera D. The importance of negative defensive medicine in the effects of malpractice reform. Eur J Health Econ 2016;17:355–69. 10.1007/s10198-015-0687-8 [PubMed] [CrossRef] [Google Scholar]

113. Morrisey MA, Kilgore ML, Nelson LJ. Medical malpractice reform and employer-sponsored health insurance premiums. Health Serv Res 2008;43:2124–42. 10.1111/j.1475-6773.2008.00869.x [PMC free article] [PubMed] [CrossRef] [Google Scholar]

114. Nahed BV, Babu MA, Smith TR, et al.. Malpractice liability and defensive medicine: a national survey of neurosurgeons. PLoS One 2012;7:e39237. 10.1371/journal.pone.0039237 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

115. O'Leary KJ, Choi J, Watson K, et al.. Medical students' and residents' clinical and educational experiences with defensive medicine. Acad Med 2012;87:142–8. 10.1097/ACM.0b013e31823f2c86 [PubMed] [CrossRef] [Google Scholar]

116. Paik M, Black B, Hyman DA. Damage caps and defensive medicine, revisited. J Health Econ 2017;51:84–97. 10.1016/j.jhealeco.2016.11.001 [PubMed] [CrossRef] [Google Scholar]

117. Patel R, Rynecki N, Eidelman E, et al.. A qualitative analysis of malpractice litigation in cardiology using case summaries through a national legal database analysis. Cureus 2019;11:e5259. 10.7759/cureus.5259 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

118. Reed DA, Windish DM, Levine RB, et al.. Do fears of malpractice litigation influence teaching behaviors? Teach Learn Med 2008;20:205–11. 10.1080/10401330802199443 [PubMed] [CrossRef] [Google Scholar]

119. Reisch LM, Carney PA, Oster NV, et al.. Medical malpractice concerns and defensive medicine: a nationwide survey of breast pathologists. Am J Clin Pathol 2015;144:916–22. 10.1309/AJCP80LYIMOOUJIF [PMC free article] [PubMed] [CrossRef] [Google Scholar]

120. Reschovsky JD, Saiontz-Martinez CB. Malpractice claim fears and the costs of treating Medicare patients: a new approach to estimating the costs of defensive medicine. Health Serv Res 2018;53:1498–516. 10.1111/1475-6773.12660 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

121. Ridic G, Howard T, Ridic O. Medical malpractice in connecticut: defensive medicine, real problem or a red herring - example of assessment of quality outcomes variables. Acta Inform Med 2012;20:32–9. 10.5455/aim.2012.20.32-39 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

122. Rodriguez RM, Anglin D, Hankin A, et al.. A longitudinal study of emergency medicine residents' malpractice fear and defensive medicine. Acad Emerg Med 2007;14:569–73. 10.1197/j.aem.2007.01.020 [PubMed] [CrossRef] [Google Scholar]

123. Rothberg MB, Class J, Bishop TF, et al.. The cost of defensive medicine on 3 Hospital medicine services. JAMA Intern Med 2014;174:1867–8. 10.1001/jamainternmed.2014.4649 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

124. Saint S, Vaughn VM, Chopra V, et al.. Perception of resources spent on defensive medicine and history of being sued among hospitalists: results from a national survey. J Hosp Med 2018;13:26–9. 10.12788/jhm.2800 [PubMed] [CrossRef] [Google Scholar]

125. Sathiyakumar V, Jahangir AA, Mir HR, et al.. The prevalence and costs of defensive medicine among orthopaedic trauma surgeons: a national survey study. J Orthop Trauma 2013;27:592–7. 10.1097/BOT.0b013e31828b7ab4 [PubMed] [CrossRef] [Google Scholar]

126. Sethi MK, Obremskey WT, Natividad H. Incidence and costs of defensive medicine among orthopedic surgeons in the United States: a national survey study. Am J Orthop 2012;41:69–73. [PubMed] [Google Scholar]

127. , Simianu VV, Grounds MA, et al., Writing Group for CERTAIN-CHOICES . Understanding clinical and non-clinical decisions under uncertainty: a scenario-based survey. BMC Med Inform Decis Mak 2016;16:153. 10.1186/s12911-016-0391-3 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

128. Sloan FA, Shadle JH. Is there empirical evidence for "Defensive Medicine"? A reassessment. J Health Econ 2009;28:481–91. 10.1016/j.jhealeco.2008.12.006 [PubMed] [CrossRef] [Google Scholar]

129. Smith-Bindman R, McCulloch CE, Ding A, et al.. Diagnostic imaging rates for head injury in the ED and states' medical malpractice tort reforms. Am J Emerg Med 2011;29:656–64. 10.1016/j.ajem.2010.01.038 [PubMed] [CrossRef] [Google Scholar]

130. Smith TR, Habib A, Rosenow JM, et al.. Defensive medicine in neurosurgery: does state-level liability risk matter? Neurosurgery 2015;76:105–13. discussion 13-4. 10.1227/NEU.0000000000000576 [PubMed] [CrossRef] [Google Scholar]

131. Thomas JW, Ziller EC, Thayer DA. Low costs of defensive medicine, small savings from tort reform. Health Aff 2010;29:1578–84. 10.1377/hlthaff.2010.0146 [PubMed] [CrossRef] [Google Scholar]

132. Thompson MS, King CP. Physician perceptions of medical malpractice and defensive medicine. Eval Program Plann 1984;7:95–104. 10.1016/0149-7189(84)90029-6 [PubMed] [CrossRef] [Google Scholar]

133. Titus LJ, Reisch LM, Tosteson ANA, et al.. Malpractice concerns, defensive medicine, and the histopathology diagnosis of melanocytic skin lesions. Am J Clin Pathol 2018;150:338–45. 10.1093/ajcp/aqy057 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

134. Tussing AD, Wojtowycz MA, Malpractice WMA. Malpractice, defensive medicine, and obstetric behavior. Med Care 1997;35:172–91. 10.1097/00005650-199702000-00007 [PubMed] [CrossRef] [Google Scholar]

135. Waxman DA, Greenberg MD, Ridgely MS, et al.. The effect of malpractice reform on emergency department care. N Engl J Med 2014;371:1518–25. 10.1056/NEJMsa1313308 [PubMed] [CrossRef] [Google Scholar]

136. Welsh JM, Alexander JL, Ewing H, et al.. Pas, NPS and defensive medicine in the ED. Adv NPs PAs 2010;1:12. [PubMed] [Google Scholar]

137. Zuckerman S, claims Medical malpractice:. Legal costs, and the practice of defensive medicine. Health Aff 1984;3:128–33. [PubMed] [Google Scholar]

138. Carlson JN, Foster KM, Black BS, et al.. Emergency physician practice changes after being named in a malpractice claim. Ann Emerg Med 2020;75:221–35. 10.1016/j.annemergmed.2019.07.007 [PubMed] [CrossRef] [Google Scholar]

139. Collins MF, Kneeland MD, Campion FX, et al.. Massachusetts risk management survey (MaRMS) of teaching hospital physicians. J Healthc Risk Manag 1997;17:3–11. 10.1002/jhrm.5600170202 [PubMed] [CrossRef] [Google Scholar]

140. Dy CJ, Pesko MF, Keller M, et al.. Removal of Non-economic damage caps is not associated with reductions in early imaging for low back pain. Hss J 2020;16:54–61. 10.1007/s11420-018-9650-4 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

141. LeFever D, Demand A, Kandregula S, et al.. Status of current medicolegal reform in the United States: a neurosurgical perspective. Neurosurg Focus 2020;49:E5. 10.3171/2020.8.FOCUS20616 [PubMed] [CrossRef] [Google Scholar]

142. Mushinski D, Zahran S, Frazier A. Physician behaviour, malpractice risk and defensive medicine: an investigation of cesarean deliveries. Health Econ Policy Law 2021:1–19. 10.1017/S1744133120000432 [PubMed] [CrossRef] [Google Scholar]

143. Quinn J, Chung S, Murchland A, et al.. Association between us physician malpractice claims rates and hospital admission rates among patients with Lower-Risk syncope. JAMA Netw Open 2020;3:e2025860. 10.1001/jamanetworkopen.2020.25860 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

144. Reisch LM, Flores MJ, Radick AC, et al.. Malpractice and patient safety concerns. Am J Clin Pathol 2020;154:700–7. 10.1093/ajcp/aqaa088 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

145. Villalobos A, Horný M, Hughes DR, et al.. Associations over time between paid medical malpractice claims and imaging utilization in the United States. J Am Coll Radiol 2021;18:34–41. 10.1016/j.jacr.2020.04.035 [PubMed] [CrossRef] [Google Scholar]

146. Cunningham W, Dovey S. The effect on medical practice of disciplinary complaints: potentially negative for patient care. N Z Med J 2000;113:464–7. [PubMed] [Google Scholar]

147. Krawitz R, Batcheler M. Borderline personality disorder: a pilot survey about clinician views on defensive practice. Australas Psychiatry 2006;14:320–2. 10.1080/j.1440-1665.2006.02297.x [PubMed] [CrossRef] [Google Scholar]

148. He AJ. The doctor-patient relationship, defensive medicine and Overprescription in Chinese public hospitals: evidence from a cross-sectional survey in Shenzhen City. Soc Sci Med 2014;123:64–71. 10.1016/j.socscimed.2014.10.055 [PubMed] [CrossRef] [Google Scholar]

149. Liu C, Liu C, Wang D, et al.. Knowledge, attitudes and intentions to prescribe antibiotics: a structural equation modeling study of primary care institutions in Hubei, China. Int J Environ Res Public Health 2019;16. 10.3390/ijerph16132385. [Epub ahead of print: 05 07 2019]. [PMC free article] [PubMed] [CrossRef] [Google Scholar]

150. Zhu L, Li L, Lang J. The attitudes towards defensive medicine among physicians of obstetrics and gynaecology in China: a questionnaire survey in a national Congress. BMJ Open 2018;8:e019752. 10.1136/bmjopen-2017-019752 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

151. Hiyama T, Yoshihara M, Tanaka S, et al.. Defensive medicine practices among Gastroenterologists in Japan. World J Gastroenterol 2006;12:7671–5. 10.3748/wjg.v12.i47.7671 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

152. Nakamura N, Yamashita Y. Malpractice lawsuits and change in work in Japanese surgeons. J Surg Res 2015;193:210–6. 10.1016/j.jss.2014.08.029 [PubMed] [CrossRef] [Google Scholar]

153. Moosazadeh M, Movahednia M, Movahednia N, et al.. Determining the frequency of defensive medicine among general practitioners in Southeast Iran. Int J Health Policy Manag 2014;2:119–23. 10.15171/ijhpm.2014.28 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

154. Asher E, Dvir S, Seidman DS, et al.. Defensive medicine among obstetricians and gynecologists in tertiary hospitals. PLoS One 2013;8:e57108. 10.1371/journal.pone.0057108 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

155. Asher E, Greenberg-Dotan S, Halevy J, et al.. Defensive medicine in Israel - a nationwide survey. PLoS One 2012;7:e42613. 10.1371/journal.pone.0042613 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

156. Asher E, Parag Y, Zeller L, et al.. Unconscious defensive medicine: the case of erythrocyte sedimentation rate. Eur J Intern Med 2007;18:35–8. 10.1016/j.ejim.2006.07.021 [PubMed] [CrossRef] [Google Scholar]

157. Benbassat J, Pilpel D, Schor R. Physicians' attitudes toward litigation and defensive practice: development of a scale. Behav Med 2001;27:52–60. 10.1080/08964280109595771 [PubMed] [CrossRef] [Google Scholar]

158. Reuveni I, Pelov I, Reuveni H, et al.. Cross-Sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists. BMJ Open 2017;7:e014153. 10.1136/bmjopen-2016-014153 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

159. Silberstein E, Shir-Az O, Reuveni H, et al.. Defensive medicine among plastic and aesthetic surgeons in Israel. Aesthet Surg J 2016;36:NP299–304. 10.1093/asj/sjw094 [PubMed] [CrossRef] [Google Scholar]

160. Toker A, Shvarts S, Perry ZH, et al.. Clinical guidelines, defensive medicine, and the physician between the two. Am J Otolaryngol 2004;25:245–50. 10.1016/j.amjoto.2004.02.002 [PubMed] [CrossRef] [Google Scholar]

161. Ali AA, Hummeida ME, Elhassan YAM, et al.. Concept of defensive medicine and litigation among Sudanese doctors working in obstetrics and gynecology. BMC Med Ethics 2016;17:12. 10.1186/s12910-016-0095-3 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

162. Smith TR, Hulou MM, Yan SC, et al.. Defensive medicine in neurosurgery: the Canadian experience. J Neurosurg 2016;124:1524–30. 10.3171/2015.6.JNS15764 [PubMed] [CrossRef] [Google Scholar]

163. Braschi E, Stacey D, Légaré F, et al.. Evidence-based medicine, shared decision making and the hidden curriculum: a qualitative content analysis. Perspect Med Educ 2020;9:173–80. 10.1007/s40037-020-00578-0 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

164. Broom A, Kirby E, Gibson AF, et al.. Myth, manners, and medical ritual: defensive medicine and the Fetish of antibiotics. Qual Health Res 2017;27:1994–2005. 10.1177/1049732317721478 [PubMed] [CrossRef] [Google Scholar]

165. Salem O, Forster C. Defensive medicine in general practice: recent trends and the impact of the civil liability act 2002 (NSW). J Law Med 2009;17:235–48. [PubMed] [Google Scholar]

166. Roytowski D, Smith TR, Fieggen AG, et al.. Impressions of defensive medical practice and medical litigation among South African neurosurgeons. S Afr Med J 2014;104:736–8. 10.7196/SAMJ.8336 [PubMed] [CrossRef] [Google Scholar]

167. Wong CY, Surajkumar S, Lee YV, et al.. A descriptive study of the effect of a disciplinary proceeding decision on medical practitioners' practice behaviour in the context of providing a hydrocortisone and lignocaine injection. Singapore Med J 2020;61:413–8. 10.11622/smedj.2019086 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

168. Garg K, Sharma R, Raheja A, et al.. Perceptions of Indian neurosurgeons about medicolegal issues and malpractice suits. Neurosurg Focus 2020;49:E10. 10.3171/2020.8.FOCUS20592 [PubMed] [CrossRef] [Google Scholar]

169. Lam TP, Chan TH, Sun KS. Antibiotic prescriptions by medical interns in Hong Kong: influence of the hospital settings and prescription culture. Postgrad Med J 2020;1151:558–65. 10.1136/postgradmedj-2020-138414 [PubMed] [CrossRef] [Google Scholar]

170. Rudey EL, Leal MdoC, Rego G. Defensive medicine and cesarean sections in Brazil. Medicine 2021;100:e24176. 10.1097/MD.0000000000024176 [PMC free article] [PubMed] [CrossRef] [Google Scholar]

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Studies included in the analysis listed after year of publication