Defensive Medicine in Surgical Disciplines: Attitudes and Practices Among Faculty and Residents at Iran University of Medical Sciences Publisher



Fahimi M ; Sayad S ; Noroozi M ; Gooshki ES ; Zarghami SY ; Shahrezaei A ; Forouzandeh M
Source: Journal of Medical Ethics and History of Medicine Published:2025

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. We thank the faculty and staff of Iran University of Medical Sciences for their support, and Dr. Mohammad Hossein Eftekhari for providing the validated questionnaire. The study tool was developed as part of a Ph.D. project at Tehran University of Medical Sciences (Dr. Mohammad Hossein Efterkhri), under the supervision of Dr. Ehsan Shamsi Gooshki, and was approved by the Research Ethics Committee (approval code: IR.TUMS.MEDICINE.REC.1399.731). Copyright © 2025 Tehran University of Medical Sciences.