Defensive practice among psychiatrists: a questionnaire survey
Open accessAbstract
Objective: There has been little research on the prevalence of defensive practice within hospital settings. The aim of this report was to examine the extent of defensiveness among psychiatrists and to examine the relationship between defensiveness and seniority, as well as the effect of previous experiences on the level of defensiveness. Design: A postal questionnaire survey on defensive practice. Setting: Northern Region of England. Subjects: 154 psychiatrists in the region. Results: 96 responses were received from 48 equivalent consultants, 18 specialist registrars, and 23 equivalent senior house officers. Overall, 75% of those who replied had taken defensive actions within the past month. In particular, 21% had admitted patients overcautiously and 29% had placed patients on higher levels of observations. Junior psychiatrists were particularly prone to practise defensively. Important contributing factors included previous experience of complaints (against colleague or self), critical incidents, and legal claims. Conclusion: Almost three quarters of the psychiatrists who responded had practised defensively within the past month. The higher propensity of junior trainees to practise defensively may be attributable to their lack of confidence and experience. Experience of complaints (colleague or self) and critical incidents were important factors for defensive practice. Better and more structured training might reduce the high level of defensive practice and the way complaints and investigations are handled should be improved to maintain a truly “no blame” environment conducive to learning from past experience.
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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 [276]
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Cites
Donaldson, L. (2002) · Clinical Medicine · doi:10.7861/clinmedicine.2-5-452 · Cited by 578 · see citing works
Implementing clinical governance: turning vision into reality
Halligan, A., & Donaldson, L. (2001) · BMJ · doi:10.1136/bmj.322.7299.1413 · Cited by 186 · see citing works
Positive and negative factors in defensive medicine: a questionnaire study of general practitioners
Summerton, N. (1995) · BMJ · doi:10.1136/bmj.310.6971.27 · Cited by 186 · see citing works
Parkes, H. B., & 岩元, 巌. (1971) · Kenkyusha eBooks · Cited by 129 · see citing works
Influence of Experience on Major Clinical Decisions
Meyerson, A. T. (1979) · Archives of General Psychiatry · doi:10.1001/archpsyc.1979.01780040065007 · Cited by 51 · see citing works
Litigation and defensive clinical practice: quantifying the problem
Symon, A. (2000) · Midwifery · doi:10.1054/midw.1999.0181 · Cited by 50 · see citing works
Defensive medicine during hospital obstetrical care: a by-product of the technological age
Bassett, K. L., Iyer, N. T., & Kazanjian, A. (2000) · Social Science & Medicine · doi:10.1016/s0277-9536(99)00494-3 · Cited by 47 · see citing works
McQuade, J. S. (1991) · Journal of the Royal Society of Medicine · doi:10.1177/014107689108400710 · Cited by 33 · see citing works
Medical malpractice in perspective. I--The American experience.
Quam, L., Dingwall, R. W. J., & Fenn, P. (1987) · BMJ · doi:10.1136/bmj.294.6586.1529 · Cited by 20 · see citing works
Jin, C., Novik, S., & Saravay, S. M. (2000) · General Hospital Psychiatry · doi:10.1016/s0163-8343(00)00091-8 · Cited by 16 · see citing works
Smith, R. (2000) · BMJ · doi:10.1136/bmj.321.7263.715 · Cited by 15 · see citing works
Physician perceptions of medical malpractice and defensive medicine
Thompson, M. S., & King, C. P. (1984) · Evaluation and Program Planning · doi:10.1016/0149-7189(84)90029-6 · Cited by 10 · see citing works
Open letter to the chief medical officer
Chalmers, I., & Hey, E. N. (2001) · BMJ · doi:10.1136/bmj.323.7307.280 · Cited by 6 · see citing works
Consultants' response to clinical complaints
Mulcahy, L., & Selwood, M. (1995) · BMJ · doi:10.1136/bmj.310.6988.1200 · Cited by 3 · see citing works
Physician medical malpractice.
LeMasurier, J. (1985) · PubMed · Cited by 2 · see citing works
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Research works printed but not linked: 1
- Hey E, Chalmers I. Investigating allegations of research misconduct: the vital need for due process. BMJ 2000;321:752-6.
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Galderisi, S., Appelbaum, P. S., Gill, N., Gooding, P., Herrman, H., Melillo, A., Myrick, K., Pathare, S., Savage, M., Szmukler, G., et al. (2024) · World Psychiatry · doi:10.1002/wps.21230 · Cited by 76 · see citing works
Cross-sectional survey on defensive practices and defensive behaviours among Israeli psychiatrists
Reuveni, I., Pelov, I., Reuveni, H., Bonne, O., & Canetti, L. (2017) · BMJ Open · doi:10.1136/bmjopen-2016-014153 · Cited by 43 · see citing works
Scognamiglio, P., Morena, D., Di Fazio, N., Delogu, G., Iniziato, V., La Pia, S., Saviano, P., Frati, P., & Fineschi, V. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1244101 · Cited by 19 · see citing works
- Authors
- Passmore, K., & Leung, W.-C.
- Affiliations
- Stockton Learning Disability Service , Stockton
- University of East Anglia (GB)
- Corresponding author
- Passmore, K
- Venue
- Postgraduate Medical Journal
- Publisher
- Oxford University Press (OUP)
- Published
- 2002-11-01
- Volume
- 78
- Issue
- 925
- Pages
- 671-673
- ISSN
- 0032-5473 (ISSN-L)
- 1469-0756
- PMC
- PMC1742562
- OpenAlex
- W2107825114
- Cited by
- 66
- References
- 16
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 2 · 2023: 7 · 2022: 4 · 2021: 5 · 2020: 5 · 2019: 6 · 2018: 1 · 2017: 1 · 2015: 3 · 2013: 5 · 2012: 5
- FWCI
- 5.12
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Postgraduate Medical Journal (publishedVersion)
- Europe PMC (PubMed Central) (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Health Professions › Pharmacy › Medical Malpractice and Liability Issues
- Health Sciences › Health Professions › Emergency Medical Services › Patient Safety and Medication Errors
- Health Sciences › Medicine › Family Practice › Clinical Reasoning and Diagnostic Skills
- Keywords
- defensive practice, psychiatrists, hospital psychiatry, junior trainees, medical complaints, critical incidents, legal claims, no-blame culture, medical training
- MeSH terms
- Defensive Medicine, England, Humans, Medical Staff, Hospital, Psychiatry, Surveys and Questionnaires, Medical Errors, Health Care Surveys
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