La medicina difensiva: una ricerca sul Pronto Soccorso in Italia

Abstract

[The defensive medicine: an investigation into Emergency Departments in Italy]

This article presents the results of a survey focused on the measurement of the extent of defensive behaviours within the Emergency Departments in Italy, and on the comprehension of the related reasons. Defensive medicine takes place when physicians modify their behaviour to reduce the exposure to legal claims by patients. The phenomenon is directly related to the significant growth in medical malpractice litigation over recent years. 90.5% of respondents declared that they had practiced at least one defensive medicine behaviour during the previous working month. This article discusses the factors, such as the blame culture and the increase of medical malpractice litigation, that may lead to defensive behaviours and result in negative effects both in terms of costs and patient safety. A clear need arises to promote a different approach which might cope the problem of medical error – at a cultural, organisational and legal level – just as in other organisations subjected to high-risk conditions. The deterrent of punishment does not increase the reliability of such organisations, nor improves their safety level.