Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists
Open accessAbstract
Objective: Psychiatry is a low-risk specialisation; however, there is a steady increase in malpractice claims against psychiatrists. Defensive psychiatry (DP) refers to any action undertaken by a psychiatrist to avoid malpractice liability that is not for the sole benefit of the patient's mental health and well-being. The objectives of this study were to assess the scope of DP practised by psychiatrists and to understand whether awareness of DP correlated with defensive behaviours. Methods: A questionnaire was administered to 213 Israeli psychiatry residents and certified psychiatrists during May and June 2015 regarding demographic data and experience with malpractice claims, medicolegal literature and litigation. Four clinical scenarios represented defensive behaviours and reactions (feelings and actions) to malpractice claims. Results: Forty-four (20.6%) certified psychiatrists and four (1.9%) residents were directly involved in malpractice claims, while 132 (62.1%) participants admitted to practising DP. Residents acknowledged the practice of DP more than did senior psychiatrists (p=0.038). Awareness of DP correlated with unnecessary hospitalisation of suicidal patients, increased unnecessary follow-up visits and prescribing smaller drug dosages than required for pregnant women and elderly patients. Conclusions: This study provides evidence that DP is well established in the routine clinical daily practice of psychiatrists. Further studies are needed to reveal whether DP effectively protects psychiatrists from malpractice suits or, rather, if it impedes providing quality psychiatric care and represents an economic burden that leads to more harm for the patient.
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Surveys in different countries report that the majority of interviewed psychiatrists acknowledged resorting to defensive practices that compromised the quality of care they provided.
“Although psychiatry is at low risk of malpractice claims in comparison to other specialties 275 , surveys in different countries report that the majority of interviewed psychiatrists acknowledged having resorted to defensive practices, which, in their opinion, compromised the quality of the provided care 274,276,277 .”
From Ethical challenges in contemporary psychiatry: an overview and an appraisal of possible strategies and research needs (2024) · cites this paper as [277]
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- Authors
- Reuveni, I., Pelov, I., Reuveni, H., Bonne, O., & Canetti, L.
- Affiliations
- Hadassah Medical Center (IL)
- Ben-Gurion University of the Negev (IL)
- Hebrew University of Jerusalem (IL)
- Corresponding author
- Reuveni, I
- Reuveni, H
- Venue
- BMJ Open
- Publisher
- BMJ
- Published
- 2017-03
- Volume
- 7
- Issue
- 3
- Pages
- e014153
- ISSN
- 2044-6055 (ISSN-L)
- PMC
- PMC5372095
- OpenAlex
- W2602295980
- Cited by
- 43
- References
- 26
- Citations by year
- 2026: 3 · 2025: 9 · 2024: 5 · 2023: 9 · 2022: 8 · 2021: 3 · 2020: 4 · 2018: 2
- FWCI
- 3.58
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- cc-by-nc
- Locations
- BMJ Open (publishedVersion, cc-by-nc)
- PubMed Central (publishedVersion, cc-by-nc)
- PubMed (publishedVersion)
- HighWire Press Open Archive (submittedVersion)
- Topics
- Health Sciences › Health Professions › Pharmacy › Medical Malpractice and Liability Issues
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Social Sciences › Psychology › Clinical Psychology › Healthcare Decision-Making and Restraints
- Keywords
- malpractice liability, defensive behavior, psychiatrists, psychiatric residents, suicidal patients, prescribing in pregnancy, elderly patients, medicolegal issues, quality of psychiatric care
- MeSH terms
- Defensive Medicine, Female, Humans, Internship and Residency, Israel, Male, Middle Aged, Psychiatry, Surveys and Questionnaires
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