الفهرس 
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Abstract
D
efensive medicine is defined as ordering extra treatments, tests, procedures, visits, and /or referrals or avoidance of high-risk patients or procedures primarily to protect the physician from exposure to lawsuits rather than to alter the patient’s diagnosis or treatment significantly.
Defensive medicine takes two forms: Assurance behavior (sometimes called “positive” defensive medicine and Avoidance behavior (sometimes called “negative” defensive medicine)
It was reported in other countries, but its prevalence in Egypt still unclear.
The present study aims to assess: knowledge, attitude, and practice of defensive medicine among a sample of Egyptian doctors, the association between exposure to medical error and the change in physicians’ behavior, and the impact of the climate of legal threat and the medical profession in Egypt on physicians’ behavior.
A cross-sectional quantitative study was done using a 23 point detailed self-administered questionnaire to measure ( in terms of knowledge, attitude, and prevalence) the extent and percentage of defensive medicine practice among physicians from five different specialties and to determine the impact of any experience of malpractice litigation and the climate of legal threat on physicians’ behavior.
Doctors with more than three years of experience and who agreed to participate were eligible to fill the questionnaire. The study included only Egyptian physicians working at Ain-Shams university hospitals using a convenient sample.
Out of 201 respondent physicians, only 20% knew the concept of defensive medicine, and 84.6% (N= 170) practiced one or more forms of it. The prevalence of practicing defensive medicine is almost equal among different specialties. Physicians’ most prevalent form is asking for extra un-necessary investigations (65.3%), followed by unnecessary referral to other specialists (59.4%).
More than half (51.2%) of the physicians admitted the increase in malpractice claims, 48 % (N=97) of the physicians agreed that they deal with every patient as a potential malpractice lawsuit, 20% (N=41) of them have total trust in their organizations that it will support them if they are exposed to malpractice litigation, 13.4% (N= 27) of the respondent physicians have been previously exposed to malpractice litigation, 47.3% (N=95) of physicians knew a colleague doctor that was once exposed to a malpractice lawsuit.
The majority of the respondents’ physicians (66.7%) thought about leaving the medical profession before, 23.9% (N=48) of the physicians experienced anxiety disorder that required treatment, 22.4% (N=45) of the physicians exposed to depression before. Only 19% (N=38) of them will strongly recommend the medical profession to others, and 16 % have positive feelings about the medical profession’s future in Egypt.
A logistic regression analysis was done; physicians who know the concept of DM (P=0.008) thought about leaving the medical profession (P=0.004) and who knew a colleague doctor who was previously exposed to litigation (P=0.018) were associated with more tendency to practice DM.
So, most physicians agreed that legal claims against physicians are increasing, and DM was practiced by more than 3/4 of the sampled Egyptian physicians. The most common practice is asking for an extra unnecessary investigation, which is quite a large number.