Defensive medicine in surgical disciplines: attitudes and practices among faculty and residents at Iran University of Medical Sciences

Maisam  Fahimi; Soheila  Sayad; Mahshad  Noroozi; Ehsan Shamsi  Gooshki; Seyed Yahya  Zarghami; Aidin  Shahrezaei; Mina  Forouzandeh

doi:10.18502/jmehm.v18i14.20106

Maisam Fahimi Researcher, Department of General Surgery, Firoozgar Clinical Research Development Center, School of Medicine, Iran University of Medical Sciences Tehran, Iran.
Soheila Sayad Associated Professor, Department of Surgery, Firoozgar Clinical Research Development Center, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Mahshad Noroozi Assistant Professor, Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Ehsan Shamsi Gooshki Monash Bioethics Center, Monash University, Melbourne, Australia; Associated Professor, Medical Ethics and History of Medicine Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Seyed Yahya Zarghami Assistant Professor, Division of HPB Surgery & Abdominal Organ Transplantation, Firoozgar Hospital, Iran University of Medical Sciences, Tehran, Iran
Aidin Shahrezaei Researcher, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.
Mina Forouzandeh Assistant Professor, Department of Medical Ethics, School of Medicine, Iran University of Medical Sciences, Tehran, Iran.

DOI: https://doi.org/10.18502/jmehm.v18i14.20106

Keywords: Defensive medicine; Surgical residents; Attitudes; Medical ethics; Surgeons

Abstract

Defensive medicine, driven by fear of litigation, increases healthcare costs and physician stress, particularly in high-risk specialties such as surgery. This study investigates the attitudes and practices of faculty members and residents in surgical discipline regarding defensive medicine.

In this cross-sectional study, 147 surgeons (faculty, residents, and fellows) from IUMS teaching hospitals completed a validated questionnaire assessing attitudes toward the ethicality of defensive medicine and the prevalence of defensive practices. Data were analyzed using SPSS version 24, applying chi-square tests, independent t-tests, and Mann-Whitney U tests.

Nearly half of the participants (48.9%) considered defensive practices ethical. Common defensive behaviors included consultation referrals (47.6%), unnecessary laboratory tests (36.7%), and avoidance of high-risk procedures (44.3%). Key concerns driving defensive practices were non-expert judicial rulings (35.4%), stress related to high-risk patients (34.7%), and litigation costs (35.2%). Factors such as intervention type (32%) and lack of awareness of ethical standards (27.2%) were associated with increased defensive behaviors. General surgery (29.8%) and orthopedics (17%) reported the highest conviction rates. The results showed that defensive medicine is prevalent among surgeons at IUMS due to legal fears and low self-confidence.

Enhancing targeted education and establishing clear ethical guidelines may reduce defensive practices and improve surgical care delivery.