背景:医疗决定受各种因素的影响,也受法律要求和不确定感的影响,这导致了防御医学这个术语。该研究的目的是从德国全科医生(GP)的角度评估对感知到的法律后果的恐惧对防御性医学实践的影响。
方法:2022年4月至5月进行了横断面研究。全科医生是通过德国全科医师协会家庭医学继续教育研究所的电子邮件通讯以及德国全科医师和家庭医师学院的在线平台邀请的。对法律恐惧的评估,本研究调查了防御性医学的一般评估以及防御性医学措施的原因和频率。除了描述性分析,采用逐步线性回归分析,探讨主要结局变量"对法律后果的恐惧"对防御性医学实践的潜在关联.
结果:413名平均年龄为50岁的全科医生(51%为女性)回答。大多数人认为他们对法律后果的担忧低至平均水平,而近三分之一(27%,n=113)恐惧强烈到非常强烈。关于法律的担忧,在48%(n=198)的受访者中,医患关系发挥了相当大的作用.三分之一的人估计在未来10年内被民事起诉的可能性相当高。47%(n=193)的参与者认为,被起诉的风险可以通过防御性医学大大降低。法律上的自我保护是38%的响应者(n=157)经常采取防御性行动的原因。因此,一半的受访者表示,他们每周至少进行一次不必要的实验室检查,40%的受访者表示,他们每月一次转介患者接受放射学诊断,但没有医学指征。
结论:由于法律恐惧对医疗实践有影响,法律自我保护是防御性行为的常见原因,应通过大学法律教育提高对法律的理解和知识,并对研究生学员和执业医师进行进一步培训。此外,社会对保护和防御医学现象及其后果的更深入的启示可能是减少医生对法律后果的恐惧的可能性。
Medical decisions are influenced by a variety of factors also by legal requirements and feelings of uncertainty, which results in the term defensive medicine. The aim of the study was to evaluate the influence of fears of perceived legal consequences on the practice of defensive medicine from the perspective of German general practitioners (GPs).
A cross-sectional study was performed from April to May 2022. GPs were invited via an e-mail newsletter of the Institute for Continuing Education in Family Medicine in the German Association of General Practitioners and via an online platform of the German College of General Practitioners and Family Physicians. The evaluation of legal fears, the general assessment of defensive medicine and reasons for and the frequency of defensive medical measures were surveyed in this study. Beside descriptive analyses, a stepwise linear regression analysis was used to explore potential associations between for the primary outcome variable \'fears of legal consequences\' on the practice of defensive medicine.
413 general practitioners with an average age of 50 years (51% female) responded. The majority rated their fears of legal consequences as low to average whereas for almost a third (27%, n = 113) the fears were strong to very strong. Regarding legal fears, the physician-patient-relationship played a fairly to very large role for 48% (n = 198) of the respondents. One third estimated the probability of being sued civilly in the next 10 years as rather high to very high. 47% (n = 193) of the participants assumed that the risk of being sued could mostly to very much be reduced by defensive medicine. Legal self-protection was for 38% of the responders (n = 157) quite frequently to very frequently a reason for acting defensively. Consequently, half of the respondents stated that they performed unnecessary laboratory tests at least once per week and 40% indicated that they referred patients for radiological diagnostics without medical indication once per month.
As legal fears have an influence on medical practice and legal self-protection being a frequent reason for defensive behaviour, understanding and knowledge of the law should be improved by legal education at university and further training of post-graduate trainees and practicing physicians should be implemented. Additionally, a more in-depth enlightenment of society about the phenomenon of Protective and Defensive Medicine and its consequences could be a possibility to decrease the perceived fears of legal consequences on the physicians\' side.