Defensive behavior in healthcare: the role of organizational factors

Defensive medicine occurs when a healthcare practitioner performs treatment or procedure to avoid exposure to malpractice litigation. Being the consequences of such a behavior nefarious both in terms of patient care, healthcare operations and cost, much has been done in terms of research and practice with the aim to reduce the likelihood of its occurrence. Because defensive medicine is strictly related to the doctor perception of the risk of litigation and its legal repercussions, in the last years, jurisprudence and insurance contract studies in healthcare focused on this topic, as well as national laws have been introduced with the goal of contrasting it. This paper argues and demonstrates that not only legal and insurance-related aspects may influence defensive medicine but organizational factors, such as hospital overcrowding and work overtime, may exacerbate or dampen such a phenomenon. For the purpose of this research, an ad-hoc laboratory experiment method has been designed, 60 medical doctors involved, and a total of 504 experiments executed. The main results of the experiment show that while, on one hand, hospital overcrowding leads to a reduction in overtreatment because the doctor recognizes that prescribing not strictly necessary treatments would increase congestion even more, on the other hand, when combined with the doctor’s perception of litigation risk, overcrowding exacerbates her/his instinct to adopt defensive behavior. Furthermore, previous experience in the emergency ward, age, and some personality traits of the doctor are significantly correlated to defensive behavior.