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Defensive medicine practices prevalent among plastic surgeons in Israel

Defensive medicine practices are prevalent among aesthetic and plastic surgeons in Israel, according to study results published in Aesthetic Surgery Journal.

Defensive medicine is defined by the researchers as medical practices meant to avoid malpractice liability rather than for patient benefit.

The researchers developed a questionnaire to assess the extent of intentional and unintentional defensive medicine among public and private practice plastic surgeons in Israel. The questionnaire addressed demographic information such as professional status, level of seniority, and personal experience with malpractice.

The questionnaire was given to the 108 surgeons who attended the Israeli Society of Plastic and Aesthetic Surgery national meeting in November 2014. Seventy-eight surgeons submitted their anonymous responses, though several were incomplete.

Forty respondents affirmed that they practice defensive medicine, including referring the patient for unnecessary consultations (n = 18), ordering unnecessary tests (n = 22), excising skin lesions that were not suspicious for malignancy (n = 15), and performing unnecessary administrative procedures (n = 18). Thirty-three respondents denied the use of defensive medicine practices.

Of the respondents that affirmed the practice of defensive medicine, 12 stated that they refuse to perform certain surgical procedures to avoid malpractice claims, compared with only two of the non-defensive medicine respondents who answered the same.

Regarding malpractice claims, 29 respondents affirmed previous involvement in a malpractice claim, while 44 denied any previous involvement. The researchers found a positive correlation between seniority and involvement in malpractice claims (P = .003).

All respondents indicated that they obtain some type of informed consent. Results of the questionnaire showed that 66.2% of the respondents obtain written informed consent twice in private practice, but only 40% do so twice in public practice.

Thirty-four respondents who affirmed defensive medicine practices answered that they prescribe antibiotics for more than 24 hours postoperatively, compared with 21 of the non-defensive medicine respondents. – by Talitha Bennett

Disclosure: The researchers report no relevant financial disclosures.