A national survey of defensive medicine among orthopaedic surgeons, XXXX surgeons and radiologists in Austria: evaluation of prevalence and context.

@entity1 @entity130
RATIONALE, AIMS AND OBJECTIVES: Defensive medical practice represents an increasing concern in European countries and is reported to account for rising health care expenditures. Malpractice liability, current jurisdiction and the increasing claim for accountability appear to result in additional diagnostic requests with marginal clinical benefit. Investigations that evaluate the national Austrian prevalence and contextual principles and consequences of defensive medicine are lacking so far. METHOD: Orthopaedic and @entity130 surgeons as well as radiologists from public hospitals in Austria were invited to complete a study questionnaire retrieving personal estimation of the quantity of @entity1 contacts and defensive requests in a typical month, subjective judgement of medico-legal climate, evolving defensive trends, working time usage for defensive considerations and prior confrontations with malpractice liability claims. RESULTS: The prevalence of defensive medicine was found to be 97.7%. The average orthopaedic or @entity130 surgeon requests 19.6 investigations per month for defensive reasons, which represents 28% of all diagnostic examinations. High-quality imaging modalities and short-term admissions yield increasing defensive significance. @entity1 are confronted with 1.4 liability claims per month. During the treatment of high-risk @entity1 , 81% of doctors request additional diagnostic procedures for defensive considerations. Expenditure of time for defensive practice amounts to 9.2 hours/month in radiology and to 17 and 18% of total working time, respectively, in orthopaedic and @entity130 surgery. CONCLUSION: Defensive medical practice represents a serious and common challenge in Austria. Our results indicate the urgent necessity for confrontation with and solution for the increasing effort of self-protection within the health care system.
